ICC18 LR14GP-WOP-2 5 WOP-12995 (11/25) the identification of any medical or vocational experts whose advice was obtained on our behalf in connection with the adverse benefit determination, without regard to whether the advice was relied upon in making the benefit determination. You may, in the course of this appeal, review relevant documents and submit to us written comments, documents, records and other information relevant to your claim. Our review of the appeal will be conducted by someone who is neither the individual who made the original adverse benefit determination that is the subject of the appeal, nor the subordinate of such individual. If the determination was based in whole or in part on a medical judgment, our review of the appeal will include consultation with a health care professional who has appropriate training and experience in the field of medicine involved in the medical judgment. This health care professional will be someone who is neither an individual who was consulted in connection with the original adverse benefit determination that is the subject of the appeal, nor the subordinate of such individual. Prior to rendering an adverse decision on appeal, we will provide notice to you of any new or additional evidence considered, relied upon, or generated by the plan, insurers or other persons making the benefit determination. We will also notify you if we have new or additional rationale for an adverse appeal determination. We will then provide you with a reasonable opportunity to review and respond to this new information before making our decision. The time period we have to make our determination will be tolled while we are waiting for your response. Following our review of the appeal, we will provide you with a written decision of the final determination of the claim. This decision will be issued as soon as possible, but no more than 45 days after the receipt of the appeal unless an extension is needed. An extension of 45 days will be allowed for making this decision if special circumstances are present. You will be given notice of any such extension before the end of the 45-day period. The notice will state the special circumstances involved and the date a decision is expected. If an extension is needed due to your failure to submit information necessary to decide a claim, the extension period will be tolled from the date on which notification of the extension is sent to you until the date on which you respond to the request for additional information. If we send an adverse benefit determination following our review of the appeal, the notice of the determination will be written in an understandable manner and include the following:  The specific reason(s) for the adverse benefit determination.  Reference to the specific provision on which the determination is based.  A statement that you are entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records and other information relevant to your claim.  A statement of your right to bring a civil action and any contractual statute of limitations period, including the specific calendar date on which such limitations period will expire.  If an internal rule, guideline, protocol or other similar criterion was relied upon in making the adverse benefit determination, then a copy of any such rule, guideline, protocol or other criterion will be provided free of charge.  The following statement: “You and your plan may have other voluntary alternative dispute resolution options, such as mediation. One way to find out what may be available is to contact your local U.S. Department of Labor Office and your State insurance regulatory agency.” Executed at our Home Office: 250 Marquette Avenue, Suite 900 Minneapolis, MN 55401 Amelia (Amy) J. Vaillancourt Melissa A. O'Donnell President Secretary