REVIEW WILL PRECLUDE THOSE ISSUES OR EVIDENCE FROM BEING PRESENTED
IN ANY SUBSEQUENT PROCEEDING OR JUDICIAL REVIEW OF THE CLAIM. THE REVIEW WILL
TAKE INTO ACCOUNT ALL AVAILABLE INFORMATION, REGARDLESS OF WHETHER SUCH
INFORMATION WAS SUBMITTED OR CONSIDERED IN THE INITIAL BENEFIT DETERMINATION.
The Retirement Board must render its
decision on the review of the claim no more than 60 days after the Retirement
Board's receipt of the request for review, except that this period may be
extended for an additional 60 days if the Retirement Board determines that
special circumstances (including, but not limited to, a hearing) require such
extension. If an extension of time is required, written notice of the expected
decision date and the reasons for the extension will be furnished to the
claimant before the end of the initial 60-day period. If a review of a claim is
denied, in whole or in part, the claim must receive a written notice containing:
(A)
THE SPECIFIC REASON(S) FOR THE ADVERSE DETERMINATION;
(B)
A REFERENCE TO SPECIFIC PLAN PROVISION(S) ON WHICH THE ADVERSE
DETERMINATION IS BASED;
(C)
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 CLAIMANT'S CLAIM FOR BENEFITS; AND
(D)
A STATEMENT OF THE CLAIMANT'S RIGHT TO BRING A CIVIL ACTION UNDER
SECTION 502(A) OF THE ACT.
(C)
DISABILITY CLAIMS.
(I)
INITIAL CLAIMS. THE EMPLOYEE BENEFITS DEPARTMENT WILL DECIDE A CLAIM
WITHIN 45 DAYS OF THE DATE ON WHICH THE CLAIM IS RECEIVED BY THE EMPLOYEE
BENEFITS DEPARTMENT. IF THE EMPLOYEE BENEFITS DEPARTMENT DETERMINES THAT AN
EXTENSION IS NECESSARY FOR REASONS BEYOND ITS CONTROL, THE EMPLOYEE BENEFITS
DEPARTMENT MAY EXTEND THIS PERIOD FOR AN ADDITIONAL 30 DAYS BY NOTIFYING THE
CLAIMANT OF THE REASONS FOR THE EXTENSION AND THE DATE WHEN THE CLAIMANT CAN
EXPECT TO RECEIVE A DECISION THE EMPLOYEE BENEFITS DEPARTMENT MAY ALSO EXTEND
THIS PERIOD FOR A SECOND 30 DAY PERIOD BY AGAIN COMPLYING WITH THE REQUIREMENTS
APPLICABLE TO THE INITIAL 30-DAY EXTENSION. IF AN EXTENSION IS PROVIDED IN ORDER
TO ALLOW THE CLAIMANT TIME TO PROVIDE ADDITIONAL INFORMATION NECESSARY TO REVIEW
THE CLAIM, THE RESPONSE DEADLINES APPLICABLE TO THE EMPLOYEE BENEFITS DEPARTMENT
WILL BE TOLLED UNTIL THE EARLIER OF THE DATE 45 DAYS AFTER THE DATE OF THE
REQUEST FOR ADDITIONAL INFORMATION OR THE DATE THE EMPLOYEE BENEFITS DEPARTMENT
RECEIVES THE ADDITIONAL INFORMATION. IF THE EMPLOYEE BENEFITS DEPARTMENT FAILS
TO NOTIFY THE CLAIMANT OF ITS DECISION TO GRANT OR DENY SUCH CLAIM WITHIN THE
TIME SPECIFIED BY THIS PARAGRAPH, THE CLAIMANT MAY REQUEST THE REVIEW OF HIS OR
HER CLAIM
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PURSUANT TO THE CLAIMS REVIEW PROCEDURES SET FORTH IN SECTION 9.5(C)(II) OF THE
PLAN. IF A CLAIM IS DENIED, IN WHOLE OR IN PART, THE CLAIMANT MUST RECEIVE A
WRITTEN NOTICE CONTAINING:
(A)
THE SPECIFIC REASON(S) FOR THE ADVERSE DETERMINATION;
(B)
A REFERENCE TO THE SPECIFIC PLAN PROVISION(S) ON WHICH THE ADVERSE
DETERMINATION IS BASED;
(C)
A DESCRIPTION OF