SHALL, IN FACT, DELIVER SUCH REPLY WITHIN SUCH
PERIOD.
THIS PERIOD MAY BE EXTENDED BY THE VICE PRESIDENT OF HUMAN RESOURCES
FOR UP TO 30 DAYS, PROVIDED THAT THE VICE PRESIDENT OF HUMAN RESOURCES
(I) DETERMINES THAT SUCH EXTENSION IS NECESSARY DUE TO MATTERS BEYOND HIS
CONTROL, AND (II) PROVIDES A WRITTEN OR ELECTRONIC NOTICE OF EXTENSION TO THE
CLAIMANT PRIOR TO THE TERMINATION OF THE INITIAL 45-DAY PERIOD.
IF, PRIOR TO
THE END OF THE FIRST 30-DAY EXTENSION PERIOD, THE VICE PRESIDENT OF HUMAN
RESOURCES DETERMINES THAT, DUE TO MATTERS BEYOND HIS CONTROL, HE CANNOT MAKE A
DETERMINATION WITHIN THE EXTENSION PERIOD, THE PERIOD FOR MAKING A DETERMINATION
MAY BE EXTENDED FOR AN ADDITIONAL 30 DAYS, PROVIDED THAT THE VICE PRESIDENT OF
HUMAN RESOURCES PROVIDES THE CLAIMANT WITH A NOTICE OF EXTENSION PRIOR TO THE
EXPIRATION OF THE INITIAL EXTENSION PERIOD.
IN THE EVENT THE VICE PRESIDENT OF
HUMAN RESOURCES EXTENDS THE DETERMINATION PERIOD OF ANY CLAIM DUE TO A
CLAIMANT'S FAILURE TO SUBMIT INFORMATION NECESSARY TO DECIDE THE CLAIM, THE
PERIOD FOR MAKING THE DETERMINATION SHALL BE TOLLED FROM THE DATE THE NOTICE OF
EXTENSION IS SENT TO THE CLAIMANT UNTIL THE DATE THE VICE PRESIDENT OF HUMAN
RESOURCES RECEIVES THE INFORMATION.
IF A CLAIM IS DENIED IN WHOLE OR IN PART,
THE VICE PRESIDENT OF HUMAN RESOURCES SHALL ADOPT A WRITTEN OPINION, USING
LANGUAGE CALCULATED TO BE UNDERSTOOD BY THE CLAIMANT, SETTING FORTH TO THE
EXTENT APPLICABLE:
(I)
THE SPECIFIC REASONS FOR SUCH DENIAL;
(II)
SPECIFIC REFERENCE TO PERTINENT PROVISIONS OF THIS PLAN ON WHICH
SUCH DENIAL IS BASED;
(III)
A DESCRIPTION OF ANY ADDITIONAL MATERIAL OR INFORMATION NECESSARY
FOR THE CLAIMANT TO PERFECT HIS OR HER CLAIM AND AN EXPLANATION WHY SUCH
MATERIAL OR SUCH INFORMATION IS NECESSARY;
(IV)
APPROPRIATE INFORMATION AS TO THE STEPS TO BE TAKEN IF THE
CLAIMANT WISHES TO SUBMIT THE CLAIM FOR REVIEW;
(V)
THE TIME LIMITS FOR REQUESTING A REVIEW UNDER SECTION 8.2(D) AND
FOR REVIEW UNDER SECTION 8.2(E) OF THIS PLAN;
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(VI)
A STATEMENT THAT THE CLAIMANT HAS THE RIGHT TO ARBITRATE UNDER
SECTION 8.3 OF THIS PLAN AND TO BRING A CIVIL ACTION UNDER SECTION 502(A) OF
ERISA FOLLOWING AN ADVERSE DETERMINATION ON REVIEW;
(VII)
THE DATE BY WHICH AN APPEAL MUST BE FILED WITH RESPECT TO THE
ADVERSE DETERMINATION; AND
(VIII)
IF THE ADVERSE DETERMINATION IS IN CONNECTION WITH A DISABILITY
CLAIM AND IF THE VICE PRESIDENT OF HUMAN RESOURCES RELIED ON AN INTERNAL RULE,
GUIDELINE, PROTOCOL, OR OTHER SIMILAR CRITERION IN MAKING THE ADVERSE
DETERMINATION, THE NOTICE SHALL EITHER (I) STATE THE SPECIFIC RULE, GUIDELINE,
PROTOCOL, OR OTHER SIMILAR CRITERION, OR (II) INCLUDE A STATEMENT THAT SUCH
INTERNAL RULE, GUIDELINE, PROTOCOL, OR OTHER SIMILAR CRITERION WAS RELIED UPON
IN MAKING THE ADVERSE DETERMINATION AND THAT A COPY OF SUCH INTERNAL RULE,
GUIDELINE, PROTOCOL, OR OTHER SIMILAR CRITERION SHALL BE PROVIDED FREE OF CHARGE
TO THE CLAIMANT UPON REQUEST.
(C)
NOTICE OF EXTENSION.
FOR PURPOSES OF THIS SECTION 8.2, A
"NOTICE OF EXTENSION" MEANS A