TO BE REPRESENTED BY COUNSEL.
4.
THE REVIEW BY THE COMMITTEE WILL TAKE INTO ACCOUNT ALL COMMENTS,
DOCUMENTS, RECORDS, AND OTHER INFORMATION THE CLAIMANT SUBMITS RELATING TO THE
CLAIM.
THE COMMITTEE WILL MAKE A FINAL WRITTEN DECISION ON A CLAIM REVIEW, IN
MOST CASES WITHIN SIXTY (60) DAYS AFTER RECEIPT OF A REQUEST FOR A REVIEW.
IN
SOME CASES, THE CLAIM MAY TAKE MORE TIME TO REVIEW, AND AN ADDITIONAL PROCESSING
PERIOD OF UP TO SIXTY (60) DAYS MAY BE REQUIRED.
IF THAT HAPPENS, THE CLAIMANT
WILL RECEIVE A WRITTEN NOTICE OF THAT FACT, WHICH WILL ALSO INDICATE THE SPECIAL
CIRCUMSTANCES REQUIRING THE EXTENSION OF TIME AND 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 DATE ON WHICH THE CLAIMANT RESPONDS TO THE PLAN'S REQUEST FOR INFORMATION.
5.
THE COMMITTEE DECISION ON THE CLAIM FOR REVIEW WILL BE
COMMUNICATED TO THE CLAIMANT IN WRITING.
IF AN ADVERSE BENEFIT DETERMINATION IS
MADE WITH RESPECT TO THE CLAIM, THE NOTICE WILL INCLUDE (A) THE SPECIFIC
REASON(S) FOR ANY ADVERSE BENEFIT DETERMINATION, WITH REFERENCES TO THE SPECIFIC
PLAN PROVISIONS ON WHICH THE DETERMINATION IS BASED; (B) A STATEMENT THAT THE
CLAIMANT IS ENTITLED TO RECEIVE, UPON REQUEST AND FREE OF CHARGE, REASONABLE
ACCESS TO (AND COPIES OF) ALL DOCUMENTS, RECORDS AND OTHER INFORMATION RELEVANT
TO THE CLAIM; AND (C) A STATEMENT OF THE CLAIMANT'S RIGHT TO BRING A CIVIL
ACTION UNDER SECTION 502(A) OF ERISA.
A CLAIMANT MAY NOT START A LAWSUIT TO
OBTAIN BENEFITS UNTIL AFTER HE OR SHE HAS REQUESTED A REVIEW AND A FINAL
DECISION HAS BEEN REACHED ON REVIEW, OR UNTIL THE APPROPRIATE TIME FRAME
DESCRIBED ABOVE HAS ELAPSED SINCE THE CLAIMANT FILED A REQUEST FOR REVIEW AND
YOU HAVE NOT RECEIVED A FINAL DECISION OR NOTICE THAT AN EXTENSION WILL BE
NECESSARY TO REACH A FINAL DECISION.
THE LAW ALSO PERMITS THE CLAIMANT TO
PURSUE HIS OR HER REMEDIES UNDER SECTION 502(A) OF ERISA WITHOUT EXHAUSTING
THESE APPEAL PROCEDURES IF THE PLAN HAS FAILED TO FOLLOW THEM.
B.
PLAN INTERPRETATION AND BENEFIT DETERMINATION
1.
THE COMMITTEE (OR, WHERE APPLICABLE, ANY DULY AUTHORIZED DELEGEE
OF THE COMMITTEE) SHALL HAVE THE EXCLUSIVE RIGHT, POWER, AND AUTHORITY, IN ITS
SOLE AND ABSOLUTE DISCRETION, TO ADMINISTER, APPLY AND INTERPRET THE PLAN AND
ANY OTHER DOCUMENTS, AND TO DECIDE ALL FACTUAL AND LEGAL MATTERS ARISING IN
CONNECTION WITH THE OPERATION OR ADMINISTRATION OF THE PLAN.
2.
WITHOUT LIMITING THE GENERALITY OF THE FOREGOING PARAGRAPH, THE
COMMITTEE (OR, WHERE APPLICABLE, ANY DULY AUTHORIZED DELEGEE OF THE COMMITTEE)
SHALL HAVE THE SOLE AND ABSOLUTE DISCRETIONARY AUTHORITY TO:
(A)
TAKE ALL ACTIONS AND MAKE ALL DECISIONS (INCLUDING FACTUAL
DECISIONS) WITH RESPECT TO THE ELIGIBILITY FOR, AND THE AMOUNT OF, BENEFITS
PAYABLE UNDER THE PLAN;
A-2