BENEFITS IS WHOLLY OR PARTIALLY DENIED, THE
PARTICIPANT, INACTIVE PARTICIPANT, OR BENEFICIARY (HEREINAFTER "CLAIMANT") SHALL
BE GIVEN WRITTEN NOTICE OF SUCH DENIAL WITHIN 90 DAYS AFTER THE CLAIM IS FILED,
UNLESS SPECIAL CIRCUMSTANCES REQUIRE AN EXTENSION OF TIME FOR PROCESSING THE
CLAIM. IF THERE IS AN EXTENSION, THE CLAIMANT SHALL BE NOTIFIED OF THE EXTENSION
AND THE REASON FOR THE EXTENSION WITHIN THE INITIAL 90-DAY PERIOD. THE EXTENSION
SHALL EXPIRE WITHIN 180 DAYS AFTER THE CLAIM IS FILED. SUCH NOTICE WILL INDICATE
THE REASON FOR DENIAL, THE PERTINENT PROVISIONS OF THE PLAN ON WHICH THE DENIAL
IS BASED, AN EXPLANATION OF THE CLAIMS APPEAL PROCEDURE AND APPEAL TIME LIMITS
SET FORTH HEREIN, A DESCRIPTION OF ANY ADDITIONAL MATERIAL OR INFORMATION
NECESSARY TO PERFECT THE CLAIM, AND AN EXPLANATION OF WHY SUCH MATERIAL OR
INFORMATION IS NECESSARY. THE DENIAL WILL ALSO INCLUDE A STATEMENT DESCRIBING
THE CLAIMANT'S RIGHT TO BRING AN ACTION UNDER SECTION 502(A) OF ERISA FOLLOWING
AN ADVERSE DETERMINATION ON REVIEW.
11.7.
APPEAL PROCEDURES
A.
ANY PERSON WHO HAS HAD A CLAIM FOR BENEFITS DENIED BY THE PLAN
ADMINISTRATOR, OR IS OTHERWISE ADVERSELY AFFECTED BY THE ACTION OR INACTION OF
THE PLAN ADMINISTRATOR, SHALL HAVE THE RIGHT TO REQUEST REVIEW BY THE PLAN
ADMINISTRATOR. SUCH REQUEST MUST BE IN WRITING AND MUST BE RECEIVED BY THE PLAN
ADMINISTRATOR WITHIN 60 DAYS AFTER SUCH PERSON RECEIVES NOTICE OF THE PLAN
ADMINISTRATOR'S ACTION. IF WRITTEN REQUEST FOR REVIEW IS NOT MADE WITHIN SUCH
60-DAY PERIOD, THE CLAIMANT SHALL FORFEIT HIS OR HER RIGHT TO REVIEW. THE
10
CLAIMANT OR A DULY AUTHORIZED REPRESENTATIVE OF THE CLAIMANT MAY REVIEW ALL
PERTINENT DOCUMENTS AND SUBMIT ISSUES AND COMMENTS IN WRITING.
B.
THE PLAN ADMINISTRATOR SHALL THEN REVIEW THE CLAIM. THE PLAN ADMINISTRATOR
MAY ISSUE A WRITTEN DECISION REAFFIRMING, MODIFYING, OR SETTING ASIDE ITS FORMER
ACTION WITHIN 60 DAYS AFTER RECEIPT OF THE WRITTEN REQUEST FOR A REVIEW, OR 120
DAYS IF SPECIAL CIRCUMSTANCES REQUIRE AN EXTENSION. THE CLAIMANT SHALL BE
NOTIFIED IN WRITING OF ANY SUCH EXTENSION WITHIN 60 DAYS FOLLOWING THE REQUEST
FOR A REVIEW. AN ORIGINAL OR COPY OF THE DECISION SHALL BE FURNISHED TO THE
CLAIMANT. A NOTIFICATION OF ADVERSE BENEFIT DETERMINATION SHALL SET FORTH, IN A
MANNER CALCULATED TO BE UNDERSTOOD BY THE CLAIMANT, (I) THE SPECIFIC REASON OR
REASONS FOR THE ADVERSE DETERMINATION; (II) REFERENCES TO THE SPECIFIC PLAN
PROVISIONS ON WHICH THE BENEFIT DETERMINATION IS BASED; (III) 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 FOR BENEFITS; AND (IV) DESCRIBE THE CLAIMANT'S RIGHT TO BRING AN
ACTION UNDER SECTION 502(A) OF ERISA. THE DECISION SHALL BE FINAL AND BINDING
UPON THE CLAIMANT AND THE PLAN ADMINISTRATOR AND ALL OTHER PERSONS HAVING OR
CLAIMING TO HAVE AN INTEREST IN THE PLAN OR IN ANY ACCOUNT ESTABLISHED UNDER THE
PLAN.
11.8.
NOTICES.
ANY NOTICE FROM THE BANK OR THE COMMITTEE TO A DIRECTOR,
PARTICIPANT, INACTIVE