45 DAYS AFTER THE RECEIPT THEREOF, UNLESS SPECIAL CIRCUMSTANCES
(SUCH AS THE NEED TO HOLD A HEARING OR OBTAIN ADDITIONAL INFORMATION) REQUIRE AN
EXTENSION OF THE TIME FOR PROCESSING THE APPEAL, IN WHICH EVENT THE PLAN
ADMINISTRATOR SHALL ISSUE ITS DECISION AS SOON AS POSSIBLE BUT NOT LATER THAN 90
DAYS FROM THE DATE THE APPEAL IS FILED.
IF THE PLAN ADMINISTRATOR DETERMINES
THAT AN EXTENSION OF TIME FOR PROCESSING IS REQUIRED, A NOTICE OF EXTENSION
SHALL BE PROVIDED TO THE CLAIMANT PRIOR TO THE TERMINATION OF THE 45-DAY
PERIOD.
IN THE EVENT THE PLAN ADMINISTRATOR REQUIRES AN EXTENSION OF TIME TO
MAKE ITS DETERMINATION DUE TO A CLAIMANT'S FAILURE TO SUBMIT INFORMATION
NECESSARY TO DECIDE A CLAIM, THE PERIOD FOR MAKING A BENEFIT DETERMINATION SHALL
BE TOLLED FROM THE DATE THE NOTICE OF EXTENSION IS SENT TO THE CLAIMANT UNTIL
THE DATE THE PLAN ADMINISTRATOR RECEIVES THE INFORMATION.
IF THE CLAIMANT DOES
NOT REQUEST A REVIEW OF THE ADVERSE DETERMINATION WITHIN THE APPLICABLE TIME
LIMITATIONS, HE OR SHE SHALL BE BARRED AND ESTOPPED FROM CHALLENGING THE
DETERMINATION.
(E)
REVIEW OF DECISION.
THE PLAN ADMINISTRATOR SHALL PROVIDE THE
CLAIMANT AN OPPORTUNITY TO SUBMIT WRITTEN COMMENTS, DOCUMENTS, RECORDS, AND
OTHER INFORMATION RELATING TO THE CLAIM FOR BENEFITS.
THE PLAN ADMINISTRATOR
SHALL REVIEW AND 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 BENEFIT
DETERMINATION.
THE CLAIMANT SHALL BE PROVIDED 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.
A DOCUMENT, RECORD,
OR OTHER INFORMATION SHALL BE CONSIDERED RELEVANT FOR PURPOSES OF THE PRECEDING
SENTENCE IF SUCH DOCUMENT, RECORD, OR INFORMATION WAS (I) RELIED UPON BY THE
VICE PRESIDENT OF HUMAN RESOURCES IN MAKING THE BENEFIT DETERMINATION, (II) WAS
SUBMITTED, CONSIDERED, OR GENERATED IN THE COURSE OF MAKING THE BENEFIT
DETERMINATION, WITHOUT REGARD TO WHETHER SUCH DOCUMENT, RECORD, OR OTHER
INFORMATION WAS RELIED UPON BY THE VICE PRESIDENT OF HUMAN RESOURCES IN MAKING
THE BENEFIT DETERMINATION, OR (III) DEMONSTRATES COMPLIANCE WITH THE
ADMINISTRATIVE PROCESSES AND SAFEGUARDS REQUIRED UNDER DEPARTMENT OF LABOR
REGULATION SECTION 2560.501-1.
IN ADDITION, IN THE EVENT OF AN ADVERSE
DETERMINATION OF A DISABILITY CLAIM, (I) ANY MEMBER OF THE PLAN ADMINISTRATOR
WHO IS EITHER THE VICE PRESIDENT OF HUMAN RESOURCES WHO ISSUED THE INITIAL
ADVERSE DETERMINATION OR A SUBORDINATE OF SUCH INDIVIDUAL SHALL NOT PARTICIPATE
WITH THE PLAN ADMINISTRATOR FOR PURPOSES OF THE REVIEW OF SUCH CLAIM, AND
(II) THE PLAN ADMINISTRATOR SHALL NOT PROVIDE ANY DEFERENCE TO THE INITIAL
ADVERSE DETERMINATION OF THE VICE PRESIDENT OF HUMAN RESOURCES.
IF THE APPEAL
OF A DISABILITY CLAIM IS BASED IN WHOLE OR IN PART ON A MEDICAL JUDGMENT, THE
PLAN ADMINISTRATOR SHALL CONSULT WITH A HEALTH CARE PROFESSIONAL WHO HAS
APPROPRIATE TRAINING AND EXPERIENCE IN THE FIELD OF MEDICINE INVOLVED IN THE
MEDICAL JUDGMENT.
ANY HEALTH CARE PROFESSIONAL THE PLAN ADMINISTRATOR ENGAGES