AN APPEAL THAT IS NOT TIMELY FILED SHALL BE BARRED.
(II)
THE PLAN ADMINISTRATOR, WITHIN THIRTY (30)
DAYS OF RECEIPT OF THE NOTICE OF APPEAL OF THE CLAIMANT, SHALL ESTABLISH A
HEARING DATE ON WHICH THE CLAIMANT (OR HIS ATTORNEY OR OTHER AUTHORIZED
REPRESENTATIVE) MAY MAKE AN ORAL PRESENTATION TO THE PLAN ADMINISTRATOR IN
SUPPORT OF THE APPEAL OF THE CLAIMANT.
THE CLAIMANT (OR REPRESENTATIVE) SHALL
HAVE THE RIGHT TO SUBMIT WRITTEN OR ORAL EVIDENCE AND ARGUMENT IN SUPPORT OF
HIS/HER CLAIM AT SUCH HEARING.
THE CLAIMANT SHALL BE GIVEN NOT LESS THAN TEN
(10) DAYS' NOTICE OF THE DATE SET FOR THE HEARING.
AT THE HEARING (OR PRIOR
THERETO UPON FIVE (5) BUSINESS DAYS' WRITTEN NOTICE TO THE PLAN
8
ADMINISTRATOR), THE CLAIMANT (OR REPRESENTATIVE) SHALL HAVE AN OPPORTUNITY TO
REVIEW ALL DOCUMENTS, RECORDS, AND OTHER INFORMATION WHICH ARE PERTINENT TO THE
CLAIM AT ISSUE AND TO RECEIVE COPIES THEREOF WITHOUT CHARGE.
(III)
THE PLAN ADMINISTRATOR SHALL CONSIDER THE
MERITS OF THE WRITTEN AND ORAL PRESENTATIONS OF THE CLAIMANT, THE MERITS OF ANY
FACTS OR EVIDENCE IN SUPPORT OF THE DENIAL OF BENEFITS, AND SUCH OTHER FACTS AND
CIRCUMSTANCES AS THE PLAN ADMINISTRATOR SHALL DEEM RELEVANT.
IF THE CLAIMANT
ELECTS NOT TO MAKE AN ORAL PRESENTATION, SUCH ELECTION SHALL NOT BE DEEMED
ADVERSE TO HIS/HER INTEREST, AND THE PLAN ADMINISTRATOR SHALL PROCEED AS SET
FORTH BELOW AS THOUGH AN ORAL PRESENTATION OF THE CONTENTS OF THE CLAIMANT'S
WRITTEN PRESENTATION HAD BEEN MADE.
(IV)
THE PLAN ADMINISTRATOR SHALL RENDER A
DETERMINATION WITHIN SIXTH (60) DAYS OF THE RECEIPT OF THE APPEAL (UNLESS THERE
HAS BEEN AN EXTENSION OF NO MORE THAN SIXTY (60) DAYS DUE TO SPECIAL
CIRCUMSTANCES, PROVIDED THAT THE DELAY AND THE SPECIAL CIRCUMSTANCES OCCASIONING
IT ARE COMMUNICATED TO THE CLAIMANT IN WRITING WITHIN THE FIRST SIXTY (60) DAY
PERIOD).
THAT DETERMINATION SHALL BE ACCOMPANIED BY A WRITTEN STATEMENT
PRESENTED IN A MANNER CALCULATED TO BE UNDERSTOOD BY THE CLAIMANT AND SHALL
INCLUDE SPECIFIC REASONS FOR THE DETERMINATION AND SPECIFIC REFERENCES TO THE
PERTINENT PROVISIONS OF THE PLAN ON WHICH THE DETERMINATION IS BASED.
THE
DETERMINATION SO RENDERED SHALL BE BINDING UPON ALL PARTIES.
THE PLAN
ADMINISTRATOR SHALL PROVIDE SUCH ACCESS TO, AND COPIES OF, DOCUMENTS, RECORDS,
AND OTHER INFORMATION RELEVANT TO THE CLAIMANT'S CLAIM FOR BENEFITS.
(C)
IF, AFTER EXHAUSTING THE APPEALS PROCESS
SET FORTH IN PARAGRAPH (B) ABOVE, THE CLAIMANT ELECTS TO FURTHER APPEAL THE
DECISION OF THE PLAN ADMINISTRATOR, THE CLAIMANT SHALL SUBMIT HIS/HER APPEAL TO
ARBITRATION (HEREINAFTER "CLAIM").
EXCEPT AS PROVIDED HEREIN, THE CLAIM SHALL
BE SUBMITTED TO ARBITRATION IN ACCORDANCE WITH THE NATIONAL RULES FOR THE
RESOLUTION OF EMPLOYMENT DISPUTES OF THE AMERICAN ARBITRATION ASSOCIATION
("AAA") THEN IN EFFECT.
BY PARTICIPATION IN THIS PLAN, EACH CLAIMANT
ACKNOWLEDGES AND AGREES THAT HIS/HER RIGHT TO SEEK RELIEF AND REMEDIES IN A
FEDERAL OR STATE COURT, INCLUDING, BUT NOT LIMITED TO A JURY TRIAL, SHALL BE
WAIVED.
THE TIME LIMITATION FOR SUBMITTING A CLAIM TO ARBITRATION SHALL BE
THIRTY (30) DAYS FROM THE DATE OF