SHALL BE MADE IN WRITING TO A
PERSON DESIGNATED BY THE COMMITTEE FROM TIME TO TIME FOR SUCH PURPOSE.
IF THE
DESIGNATED PERSON RECEIVING A CLAIM BELIEVES THAT THE CLAIM SHOULD BE DENIED, HE
OR SHE SHALL NOTIFY THE CLAIMANT IN WRITING OF THE DENIAL OF THE CLAIM WITHIN
NINETY (90) DAYS AFTER HIS OR HER RECEIPT THEREOF.
THIS PERIOD MAY BE EXTENDED
AN ADDITIONAL NINETY (90) DAYS IN SPECIAL CIRCUMSTANCES AND, IN SUCH EVENT, THE
CLAIMANT SHALL BE NOTIFIED IN WRITING OF THE EXTENSION, THE SPECIAL
CIRCUMSTANCES REQUIRING THE EXTENSION OF TIME AND THE DATE BY WHICH THE
COMMITTEE'S DESIGNEE EXPECTS TO MAKE A DETERMINATION WITH RESPECT TO THE CLAIM.
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 UNTIL THE DATE ON
WHICH THE CLAIMANT RESPONDS TO THE PLAN'S REQUEST FOR INFORMATION.
2.
IF A CLAIM IS DENIED IN WHOLE OR IN PART, OR ANY ADVERSE BENEFIT
DETERMINATION IS MADE WITH RESPECT TO THE CLAIM, THE CLAIMANT WILL BE PROVIDED
WITH A WRITTEN NOTICE SETTING FORTH (A) THE SPECIFIC REASON OR REASONS FOR THE
DENIAL MAKING REFERENCE TO THE PERTINENT PROVISIONS OF THE PLAN OR OF PLAN
DOCUMENTS ON WHICH THE DENIAL IS BASED, (B) A DESCRIPTION OF ANY ADDITIONAL
MATERIAL OR INFORMATION NECESSARY TO PERFECT OR EVALUATE THE CLAIM, AND EXPLAIN
WHY SUCH MATERIAL OR INFORMATION, IF ANY, IS NECESSARY, AND (C) INFORM THE
CLAIMANT OF HIS OR HER RIGHT, PURSUANT TO PARAGRAPH A(1) OF THIS EXHIBIT, TO
REQUEST REVIEW OF THE DECISION.
THE NOTICE SHALL ALSO PROVIDE AN EXPLANATION OF
THE PLAN'S CLAIMS REVIEW PROCEDURE AND THE TIME LIMITS APPLICABLE TO SUCH
PROCEDURE, AS WELL AS A STATEMENT OF THE CLAIMANT'S RIGHT TO BRING A CIVIL
ACTION UNDER SECTION 502(A) OF ERISA FOLLOWING AN ADVERSE BENEFIT DETERMINATION
ON REVIEW.
IF A CLAIMANT IS NOT NOTIFIED (OF THE DENIAL OR AN EXTENSION) WITHIN
NINETY (90) DAYS FROM THE DATE THE CLAIMANT NOTIFIES THE COMMITTEE'S DESIGNEE,
THE CLAIMANT MAY REQUEST A REVIEW OF THE APPLICATION AS IF THE CLAIM HAD BEEN
DENIED.
3.
A CLAIMANT MAY APPEAL THE DENIAL OF A CLAIM BY SUBMITTING A
WRITTEN REQUEST FOR REVIEW TO THE COMMITTEE, WITHIN SIXTY (60) DAYS AFTER
WRITTEN NOTIFICATION OF DENIAL IS RECEIVED.
SUCH PERIOD MAY BE EXTENDED BY THE
COMMITTEE FOR GOOD CAUSE SHOWN.
THE CLAIM WILL THEN BE REVIEWED BY THE
COMMITTEE.
IN CONNECTION WITH THIS APPEAL, THE CLAIMANT (OR HIS OR HER DULY
AUTHORIZED REPRESENTATIVE) MAY (A) BE PROVIDED, UPON WRITTEN REQUEST AND FREE OF
CHARGE, WITH REASONABLE ACCESS TO (AND COPIES OF) ALL DOCUMENTS, RECORDS, AND
OTHER INFORMATION RELEVANT TO THE CLAIM; AND (B) SUBMIT TO THE COMMITTEE WRITTEN
COMMENTS, DOCUMENTS, RECORDS, AND OTHER
A-1
INFORMATION RELATED TO THE CLAIM.
IF THE COMMITTEE DEEMS IT APPROPRIATE, IT MAY
HOLD A HEARING AS TO A CLAIM.
IF A HEARING IS HELD, THE CLAIMANT SHALL BE
ENTITLED