ENFORCE SUCH RESTRICTIVE
COVENANT TO THE MAXIMUM EXTENT PERMITTED UNDER THE LAW AS TO AREA, BREADTH AND
DURATION.
5.4.4
CHANGE IN CONTROL.
THE NON-COMPETE PROVISION DETAILED IN SECTION 5.4.1
HEREOF SHALL NOT BE ENFORCEABLE FOLLOWING A CHANGE IN CONTROL.
5.5
SUICIDE OR MISSTATEMENT.
NO BENEFITS SHALL BE PAYABLE IF THE EXECUTIVE
COMMITS SUICIDE WITHIN TWO (2) YEARS AFTER THE DATE OF THIS AGREEMENT, OR IF AN
INSURANCE COMPANY (IF APPLICABLE) DENIES COVERAGE FOR MATERIAL MISSTATEMENTS OF
FACT MADE BY THE EXECUTIVE ON ANY APPLICATION FOR LIFE INSURANCE PURCHASED BY
PSB.
ARTICLE 6
CLAIMS AND REVIEW PROCEDURES
6.1
CLAIMS PROCEDURE.
THE EXECUTIVE OR A BENEFICIARY ("CLAIMANT") WHO HAS NOT
RECEIVED BENEFITS UNDER THE AGREEMENT THAT HE OR SHE BELIEVES SHOULD BE PAID
SHALL MAKE A CLAIM FOR SUCH BENEFITS AS FOLLOWS:
6.1.1
INITIATION - WRITTEN CLAIM.
THE CLAIMANT INITIATES A CLAIM BY SUBMITTING
TO PSB A WRITTEN CLAIM FOR THE BENEFITS.
6.1.2
TIMING OF PSB RESPONSE.
PSB SHALL RESPOND TO SUCH CLAIMANT WITHIN
90 DAYS AFTER RECEIVING THE CLAIM.
IF PSB DETERMINES THAT SPECIAL CIRCUMSTANCES
REQUIRE ADDITIONAL TIME FOR PROCESSING THE CLAIM, PSB CAN EXTEND THE RESPONSE
PERIOD BY AN ADDITIONAL 90 DAYS BY NOTIFYING THE CLAIMANT IN WRITING, PRIOR TO
THE END OF THE INITIAL 90-DAY PERIOD, THAT AN ADDITIONAL PERIOD IS REQUIRED.
THE NOTICE OF EXTENSION MUST SET FORTH THE SPECIAL CIRCUMSTANCES AND THE DATE BY
WHICH PSB EXPECTS TO RENDER ITS DECISION.
6.1.3
NOTICE OF DECISION.
IF PSB DENIES PART OR ALL OF THE CLAIM, PSB SHALL
NOTIFY THE CLAIMANT IN WRITING OF SUCH DENIAL.
PSB SHALL WRITE THE NOTIFICATION
IN A MANNER CALCULATED TO BE UNDERSTOOD BY THE CLAIMANT. THE NOTIFICATION SHALL
SET FORTH:
(I)
THE SPECIFIC REASONS FOR THE DENIAL,
(II)
A REFERENCE TO THE SPECIFIC PROVISIONS OF THE AGREEMENT ON WHICH THE
DENIAL IS BASED,
(III)
A DESCRIPTION OF ANY ADDITIONAL INFORMATION OR MATERIAL NECESSARY FOR THE
CLAIMANT TO PERFECT THE CLAIM AND AN EXPLANATION OF WHY IT IS NEEDED,
(IV)
AN EXPLANATION OF THE AGREEMENT'S REVIEW PROCEDURES AND THE TIME LIMITS
APPLICABLE TO SUCH PROCEDURES, AND
(V)
A STATEMENT OF THE CLAIMANT'S RIGHT TO BRING A CIVIL ACTION UNDER ERISA
SECTION 502(A) FOLLOWING AN ADVERSE BENEFIT DETERMINATION ON REVIEW.
6.2
REVIEW PROCEDURE.
IF PSB DENIES PART OR ALL OF THE CLAIM, THE CLAIMANT
SHALL HAVE THE OPPORTUNITY FOR A FULL AND FAIR REVIEW BY PSB OF THE DENIAL, AS
FOLLOWS:
9
6.2.1
INITIATION - WRITTEN REQUEST.
TO INITIATE THE REVIEW, THE CLAIMANT,
WITHIN 60 DAYS AFTER RECEIVING PSB'S NOTICE OF DENIAL, MUST FILE WITH PSB A
WRITTEN REQUEST FOR REVIEW.
6.2.2
ADDITIONAL SUBMISSIONS - INFORMATION ACCESS.
THE CLAIMANT SHALL THEN
HAVE THE OPPORTUNITY TO SUBMIT WRITTEN COMMENTS, DOCUMENTS, RECORDS AND OTHER
INFORMATION RELATING TO THE CLAIM.
PSB SHALL ALSO PROVIDE THE CLAIMANT, UPON
REQUEST AND FREE OF CHARGE, REASONABLE ACCESS TO, AND COPIES OF, ALL DOCUMENTS,
RECORDS AND OTHER INFORMATION RELEVANT (AS DEFINED IN APPLICABLE ERISA
REGULATIONS) TO THE CLAIMANT'S CLAIM FOR BENEFITS.
6.2.3
CONSIDERATIONS ON REVIEW.
IN CONSIDERING THE REVIEW, PSB SHALL