THE CLAIMANT RELATING TO THE CLAIM, WITHOUT
REGARD TO WHETHER SUCH INFORMATION WAS SUBMITTED OR CONSIDERED IN THE INITIAL
CLAIM DETERMINATION.
(II)
THE DECISION OF THE COMMITTEE UPON REVIEW
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,
WITH RESPECT TO ANY CLAIM, THE SIXTY (60) DAY PERIOD MAY BE EXTENDED FOR A
PERIOD OF UP TO ONE HUNDRED TWENTY (120) DAYS.
IF THE SIXTY (60) DAY PERIOD IS EXTENDED, THE COMMITTEE OR ITS DESIGNEE 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 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 SHALL 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 COMMITTEE'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.
(III)
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.
8
(IV)
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.
(V)
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:
(A)
THE SPECIFIC REASON OR REASONS FOR THE
DECISION, 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.
(C)
ALL INTERPRETATIONS, DETERMINATIONS AND
DECISIONS OF THE COMMITTEE WITH RESPECT TO ANY CLAIM, INCLUDING WITHOUT
LIMITATION THE APPEAL OF ANY CLAIM, SHALL BE MADE BY THE COMMITTEE, IN ITS SOLE
DISCRETION, BASED ON THE PLAN AND COMMENTS, DOCUMENTS, RECORDS, AND OTHER
INFORMATION PRESENTED TO IT, AND SHALL BE FINAL, CONCLUSIVE AND BINDING.
(D)
THE CLAIMS PROCEDURES SET FORTH IN THIS
SECTION ARE INTENDED TO COMPLY WITH UNITED STATES DEPARTMENT OF LABOR REGULATION
§ 2560.503-1 AND SHOULD BE CONSTRUED IN ACCORDANCE WITH SUCH REGULATION. IN NO