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( i ) he or she is incapacitated , or he or she is a full-time student attending an educational institution and the months during the year which he or she attended such institution . ( i ) If a Participant fails to submit a claim within the number of days listed in the Adoption Information immediately following the end of the Plan Year or within the number of days listed in the Adoption Information immediately following termination of employment, those claims shall not be considered for reimbursement by the Administrator. ARTICLE VIII BENEFITS AND RIGHTS 8 . 1 CLAIM FOR BENEFITS ( a ) Any claim for Benefits underwritten by an Insurance Contract shall be made to the Insurer. If the Insurer denies any claim , the Participant or beneficiary shall follow the Insurer's claims review procedure . Any other claim for Benefits shall be made to the Administrator. If the Administrator denies a claim , the Administrator may provide notice to the Participant or beneficiary , in writing , within 90 days after the claim is filed unless special circumstances require an extension of time for processing the claim . If the Administrator does not notify the Participant of the denial of the claim within the 90 day period specified above , then the claim shall be deemed denied . The notice of a denial of a claim shall be written in a manner calculated to be understood by the claimant and shall set forth : ( 1 ) specific references to the pertinent Plan provisions on which the denial is based ; ( 2 ) a description of any additional material or information necessary for the claimant to perfect the claim and an explanation as to why such information is necessary; and ( 3 ) an explanation of the Plan ' s claim procedure . ( b ) Within 60 days after receipt of the above material , the claimant shall have a reasonable opportunity to appeal the claim denial to the Administrator for a full and fair review . The claimant or his duly authorized representative may: ( 1 ) request a review upon written notice to the Administrator ; ( 2 ) review pertinent documents ; and ( 3 ) submit issues and comments in writing . ( c ) A decision on the review by the Administrator will be made not later than 60 days after receipt of a request for review , unless special circumstances require an extension of time for processing ( such as the need to hold a hearing ) , in which event a decision should be rendered as soon as 19