claim payment any unpaid premium due for the Insured’s coverage. We will not recover more money from the Insured than the benefit amounts we paid to the Insured. If the overpayment is due to the Insured’s receipt of amounts from a third party by judgment, settlement or otherwise for a Total Disability caused or contributed to by an act or omission of the third party, the Insured is obligated to repay us for the overpayment in full regardless of whether the Insured has been fully compensated for the Insured’s injuries. If the overpayment results from our having made a payment to the Insured that should have been made under another group plan, we may recover such overpayment from one or more of the following: (1) any other insurance company; (2) any other organization; or (3) any person to or for whom payment was made. SUBROGATION: If Monthly Benefits are paid or payable to the Insured under the Policy as the result of any act or omission of a third party, we will be subrogated to all rights of recovery the Insured may have in respect to such act or omission. The Insured must execute and deliver to us such instruments and papers as may be required and do whatever else is needed to secure such rights. The Insured must avoid doing anything that would prejudice our rights of subrogation. If the Insured notifies us before filing suit or settling the Insured’s claim against such third party, the amount to which we are subrogated will be reduced by a pro rata share of the Insured’s costs of recovery, including reasonable attorney fees. If suit or action is filed, we may record a notice of payments of Monthly Benefits, and such notice shall constitute a lien on any judgment recovered. If the Insured or the Insured’s legal representative fail to bring suit or action promptly against such third party, we may institute such suit or action in our name or in the Insured’s name. We are entitled to retain from any judgment recovered the amount of Monthly Benefits paid or to be paid to the Insured or on the Insured’s behalf, together with our costs of recovery, including attorney fees. The remainder of such recovery, if any, shall be paid to the Insured or as the court may direct. If we bring a legal action against the third party on the Insured’s behalf, we will not reduce the Insured’s Monthly Benefits by any other amounts the Insured receives from the third party. NOTIFICATION OF CLAIM DECISIONS: We will send the Insured written notice of our claim decision within a reasonable period of time, but not later than 45 days after we receive proof of the Insured’s claim. If it is determined that an extension of time is needed to make a benefit determination, we will send the Insured a written notice within this initial 45 day timeframe that an additional 30 days is needed. If, prior to the end of the first 30-day extension period, it is determined that, due to matters beyond our control, a claim decision cannot be made within that extension period, we will send the Insured written notice during the initial 30 day extension that the period for making the determination may be extended for up to an additional 30 days. This notice will include the date by which a decision is expected to be made. In the case of any such extension, the notice of extension shall specifically explain the standards on which entitlement to a benefit is based, the unresolved issues that prevent a decision on the claim, and the additional information needed to resolve those issues, and the Insured will have 45 days within which to provide the specified information. The period of time within which a benefit decision is required to be made shall begin at the time a claim is filed, without regard to whether all the information necessary to make a benefit decision accompanies the filing. In the event that a period of time is extended due to the Insured’s failure to submit information necessary to decide a claim, the period for making the benefit decision shall be tolled from the date on which the notification of the extension is sent to the Insured until the date on which the Insured responds to the request for additional information. For any adverse benefit decision, our notice will include: (1) The specific reason or reasons for such decision; (2) Reference to specific plan/Policy provisions on which the decision was based; (3) A description of the additional material or information necessary for the Insured to perfect the claim and an explanation of why such material or information is necessary; (4) A description of the review procedures and the time limits applicable to such procedures, including a statement of the Insured’s right to bring a civil action under section 502(a) of the Employee Retirement Income Security Act of 1974 as amended ("ERISA") (where applicable), following an adverse benefit decision; (5) A discussion of the decision, including an explanation of the basis for disagreeing with or not following: a) The views presented by the Insured to the plan of health care professionals treating the Insured and vocational professionals who evaluated the Insured; b) The views of medical or vocational experts whose advice was obtained on behalf of the plan in connection with the Insured’s adverse benefit decision, without regard to whether the advice was relied upon in making the benefit decision; and c) A disability determination regarding the Insured made by the Social Security Administration; LRS-6564-6-0719-IN Page 6.2