AFTER THE CLAIMANT RECEIVES NOTIFICATION OF DENIAL OR, IF
NO NOTIFICATION WAS PROVIDED, THE DATE THE CLAIM IS DEEMED DENIED.
THE CLAIMANT
OR HIS DULY AUTHORIZED REPRESENTATIVE MAY:
(I)
UPON REQUEST AND FREE OF CHARGE, BE PROVIDED WITH REASONABLE
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.
(C)
THE DECISION OF THE COMMITTEE SHALL BE MADE
WITHIN SIXTY
(60) DAYS AFTER RECEIPT OF THE CLAIMANT'S REQUEST FOR REVIEW,
UNLESS SPECIAL CIRCUMSTANCES (INCLUDING, WITHOUT LIMITATION, THE NEED TO HOLD A
HEARING) REQUIRE AN EXTENSION. IN THE EVENT OF SPECIAL CIRCUMSTANCES, THE SIXTY
(60) DAY PERIOD MAY BE EXTENDED FOR A PERIOD OF UP TO ONE HUNDRED TWENTY (120)
DAYS.
IF THE INITIAL SIXTY (60) DAY PERIOD IS EXTENDED, THE COMMITTEE SHALL, WITHIN
SIXTY (60) DAYS OF RECEIPT OF THE CLAIM FOR REVIEW, NOTIFY THE CLAIMANT IN
WRITING.
THE WRITTEN NOTICE OF EXTENSION SHALL INDICATE THE SPECIAL
CIRCUMSTANCES REQUIRING THE
9
EXTENSION OF TIME AND PROVIDE THE DATE BY WHICH THE COMMITTEE EXPECTS TO MAKE A
DETERMINATION WITH RESPECT TO THE CLAIM UPON REVIEW.
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 FORTY-FIVE (45) DAY PERIOD COMMENCING ON
THE DATE THAT THE CLAIMANT IS NOTIFIED THAT THE REQUESTED ADDITIONAL INFORMATION
MUST BE PROVIDED. IF NOTICE OF THE DECISION UPON REVIEW IS NOT FURNISHED WITHIN
THE REQUIRED TIME PERIOD DESCRIBED HEREIN, THE CLAIM ON REVIEW SHALL BE DEEMED
DENIED AS OF THE LAST DAY OF SUCH PERIOD.
THE COMMITTEE, IN ITS SOLE DISCRETION, MAY HOLD A HEARING REGARDING THE CLAIM
AND REQUEST THAT THE CLAIMANT ATTEND.
IF A HEARING IS HELD, THE CLAIMANT SHALL
BE ENTITLED TO BE REPRESENTED BY COUNSEL.
(D)
THE COMMITTEE'S DECISION UPON REVIEW ON THE
CLAIMANT'S CLAIM SHALL BE COMMUNICATED TO THE CLAIMANT IN WRITING.
IF THE CLAIM
UPON REVIEW IS DENIED, THE NOTICE TO THE CLAIMANT SHALL SET FORTH:
(I)
THE SPECIFIC REASON OR REASONS FOR THE DECISION, WITH REFERENCES
TO THE SPECIFIC PLAN PROVISIONS ON WHICH THE DETERMINATION IS BASED;
(II)
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
(III)
A STATEMENT OF THE CLAIMANT'S RIGHT TO BRING A CIVIL ACTION UNDER
SECTION 502(A) OF ERISA.
(E)
THE COMMITTEE SHALL HAVE THE FULL POWER AND