CLAIM, PROVIDED
THAT IN THE EVENT OF SPECIAL CIRCUMSTANCES SUCH PERIOD MAY BE EXTENDED.
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(B)
IF THE INITIAL 90 DAY PERIOD IS EXTENDED, THE COMMITTEE OR ITS
DESIGNEE SHALL, WITHIN 90 DAYS OF RECEIPT OF THE CLAIM, NOTIFY THE CLAIMANT IN
WRITING OF SUCH EXTENSION.
THE WRITTEN NOTICE OF EXTENSION WILL INDICATE THE
SPECIAL CIRCUMSTANCES REQUIRING THE EXTENSION OF TIME AND PROVIDE THE DATE BY
WHICH THE COMMITTEE EXPECTS TO MAKE A DETERMINATION WITH RESPECT TO THE CLAIM.
IF THE EXTENSION IS REQUIRED DUE TO THE CLAIMANT'S FAILURE TO SUBMIT INFORMATION
NECESSARY TO DECIDE THE CLAIM, THE PERIOD FOR MAKING THE DETERMINATION WILL BE
TOLLED FROM THE DATE ON WHICH THE EXTENSION NOTICE IS SENT TO THE CLAIMANT UNTIL
THE EARLIER OF (I) THE DATE ON WHICH THE CLAIMANT RESPONDS TO THE PLAN'S REQUEST
FOR INFORMATION OR (II) EXPIRATION OF THE 45 DAY PERIOD COMMENCING ON THE DATE
THAT THE CLAIMANT IS NOTIFIED THAT THE REQUESTED ADDITIONAL INFORMATION MUST BE
PROVIDED.
IF NOTICE OF THE DENIAL OF A CLAIM IS NOT FURNISHED WITHIN THE
REQUIRED TIME PERIOD DESCRIBED HEREIN, THE CLAIM SHALL BE DEEMED DENIED AS OF
THE LAST DAY OF SUCH PERIOD.
(C)
IF THE CLAIM IS WHOLLY OR PARTIALLY DENIED, THE NOTICE TO THE
CLAIMANT SHALL SET FORTH:
(I)
THE SPECIFIC REASON OR REASONS FOR THE DENIAL;
(II)
SPECIFIC REFERENCE TO PERTINENT PLAN PROVISIONS UPON WHICH THE
DENIAL IS BASED;
(III)
A DESCRIPTION OF ANY ADDITIONAL MATERIAL OR INFORMATION NECESSARY
FOR THE CLAIMANT TO PERFECT THE CLAIM AND AN EXPLANATION OF WHY SUCH MATERIAL OR
INFORMATION IS NECESSARY;
(IV)
APPROPRIATE INFORMATION AS TO THE STEPS TO BE TAKEN AND THE
APPLICABLE TIME LIMITS IF THE CLAIMANT WISHES TO SUBMIT THE ADVERSE
DETERMINATION FOR REVIEW; AND
(V)
A STATEMENT OF THE CLAIMANT'S RIGHT TO BRING A CIVIL ACTION UNDER
SECTION 502(A) OF ERISA FOLLOWING AN ADVERSE DETERMINATION ON REVIEW
(COLLECTIVELY, THE "NOTICE REQUIREMENTS").
(D)
IF THE CLAIM HAS BEEN DENIED, THE CLAIMANT MAY SUBMIT THE CLAIM
FOR REVIEW.
ANY REQUEST FOR REVIEW OF A CLAIM MUST BE MADE IN WRITING TO THE
COMMITTEE NO LATER THAN 60 DAYS AFTER THE CLAIMANT RECEIVES NOTIFICATION OF
DENIAL OR, IF NO NOTIFICATION WAS PROVIDED, THE DATE THE CLAIM IS DEEMED
DENIED.
THE CLAIM WILL THEN BE REVIEWED BY THE COMMITTEE.
THE CLAIMANT OR HIS
DULY AUTHORIZED REPRESENTATIVE MAY:
(I)
UPON REQUEST AND FREE OF CHARGE, BE PROVIDED WITH ACCESS TO, AND
COPIES OF, RELEVANT DOCUMENTS, RECORDS, AND OTHER INFORMATION RELEVANT TO THE
CLAIMANT'S CLAIM; AND
(II)
SUBMIT WRITTEN COMMENTS, DOCUMENTS, RECORDS, AND OTHER
INFORMATION RELATING TO THE CLAIM.
THE REVIEW OF THE CLAIM DETERMINATION SHALL
TAKE INTO ACCOUNT ALL COMMENTS, DOCUMENTS, RECORDS, AND OTHER INFORMATION
SUBMITTED BY THE CLAIMANT RELATING TO THE CLAIM, WITHOUT REGARD TO WHETHER SUCH
INFORMATION WAS SUBMITTED OR CONSIDERED IN THE INITIAL CLAIM DETERMINATION.
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(E)
THE DECISION OF THE COMMITTEE SHALL BE MADE WITHIN 60 DAYS (SUCH
PERIOD MAY BE EXTENDED TO 120 DAYS)
AFTER RECEIPT OF THE CLAIMANT'S REQUEST FOR
REVIEW, UNLESS SPECIAL