determination, applying the terms of the plan to the claimant's medical circumstances, or a
statement that such explanation will be provided free of change upon request; (c) either the
specific internal rules, guidelines, protocols, standards, or other similar criteria of the plan
relied upon in making the adverse determination or, alternatively, a statement that such
rules, guidelines, protocols, standards, or other similar criteria of the plan do not exist; and
(d) 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 claimant's claim for benefits.
The claimant may submit an appeal of a benefit claim determination to the Committee within
180 days after the claimant’s receipt of the notice of the determination. Failure of the
individual to file an appeal with the Committee within the allowable 180-day period will
constitute an irrevocable consent by the individual to the Committee’s decision, and the
Committee’s notice described above shall so state.
The appeal shall provide a full and fair review of the claimant’s claim for benefits and the
adverse benefit determination that takes 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 may submit written comments, documents, records, and other information
relating to the claim for benefits in connection with the appeal. The claimant will also 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, both
in connection with the appeal and any adverse benefit determination. The appeal shall be
reviewed by an individual who was neither a party who made the initial adverse benefit
determination nor a subordinate of such a party. The review will not afford deference to the
initial adverse benefit determination and shall take into account all comments, documents,
records, and other information submitted by the claimant, without regard to whether such
information was previously submitted or relied upon in the initial determination. The
determination on appeal shall identify the medical or vocational experts whose advice was
obtained on behalf of the plan in connection with any adverse benefit determination, without
regard to whether the advice was relied upon in making the benefit determination.
Before issuing an adverse benefit determination on appeal relating to a Disability benefit
claim, the Committee shall provide the claimant, free of charge, with any new or additional
evidence considered, relied upon, or generated on behalf of or at the direction of the
individual making the benefit determination in connection with the claim. Such evidence
must be provided as soon as possible and sufficiently in advance of the date on which the
notice of adverse benefit determination on appeal is required to be provided to give the
claimant a reasonable opportunity to respond prior to that date. In addition, before issuing
an adverse benefit determination on appeal relating to a Disability benefit claim based on a
new or additional rationale, the Committee shall provide the claimant, free of charge, with the
new or additional rationale as soon as possible and sufficiently in advance of the date on
which the notice of adverse benefit determination on review is required to be provided to
give the claimant a reasonable opportunity to respond prior to that date.
Within 60 days (in the case of a claim for Disability benefits, within 45 days) after receipt of
the request for review, the Committee shall notify the claimant either as to the decision on
the appeal or that special circumstances require an extension of time for processing the