Claims and Appeal Procedures

Appeals Procedure

If the claim for benefits is denied, the Claimant has the right to appeal the adverse decision. To do so, the Claimant must submit, within 60 days following the receipt of the notice of denial, a written appeal to the Appeals Reviewer at the address provided in Administrative Information. If possible, the Claimant should include with the appeal any documents or records that support the Claimant’s appeal.

A Claimant who fails to submit a written appeal request to the Appeals Reviewer within the 60- day period will have no further right to appeal and will not be permitted to file a claim under Section 502(a) of ERISA.

The Claimant has the right to:

• Review pertinent Plan documents;
• Obtain, upon request and at no charge, reasonable access to and copies of all documents, records and other information relevant to the Claimant’s claim; and
• Submit written comments, documents, records and other information supporting the Claimant’s position.

The review will take into account all comments, documents, records, and other information the Claimant submitted, without regard to whether such information was submitted or considered in the initial claim determination. In addition, the Appeals Reviewer will follow reasonable procedures to verify that its benefit determination is made in accordance with the applicable Plan documents and the applicable provisions of such documents are applied to the Claimant in a manner consistent with how such provisions have been applied to other similarly situated Claimants.

Generally, the Claimant will receive a written decision on the appeal within 60 days of receipt of the appeal by the Appeals Reviewer, unless the Appeals Reviewer determines that special circumstances require an extension of time of up to an additional 60 days for processing the claim. If the Appeals Reviewer determines that an extension of time for processing is required, written notice of the extension will be furnished to the Claimant prior to the termination of the initial 60-day period. The extension notice will indicate the special circumstances requiring an extension of time and the date by which the Appeals Reviewer expects to render the determination on review.

If the decision of the Appeals Reviewer is adverse, the notice of decision on appeal will give specific reasons for the decision and contain references to the Plan provisions on which the decision is based. The notice will provide a statement that the Claimant has the right to obtain, upon request and at no charge, reasonable access to and copies of all documents, records and other information relevant to the Claimant’s claim and also a statement describing the Claimant’s right to bring a civil action under Section 502(a) of ERISA if the Claimant’s appeal is denied.

Nonetheless, the Plan Administrator and the Appeal Reviewer will each have the power to designate one or more persons as it deems necessary or desirable in connection with the Plan, who may or may not be employees of the Companies, to serve or perform some or all of the functions of the Plan Administrator or the Appeal Reviewer on its behalf, as outlined in Claims and Appeals Procedures. Any persons designated as Appeal Reviewer in lieu of the individual or entity named in Administrative Information will be an individual, or any subordinate of such individual, who was not consulted in connection with the adverse benefit determination that is the subject of the appeal.