(6) Either the specific internal rules, guidelines, protocols, standards or other similar criteria of the plan that we relied upon in making the adverse decision, or, alternatively, a statement that such rules, guidelines, protocols, standards or other similar criteria of the plan do not exist; (7) A statement that the Insured is entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to a claim for benefits; and (8) Information concerning the Insured’s right to request that we review our decision. The notification will be provided in a culturally and linguistically appropriate manner. REVIEW OF ADVERSE BENEFIT DECISIONS: The Insured may appeal any adverse benefit decision we may make on all or part of the Insured’s claim. This appeal must be in writing and must be received by us no more than 180 days after the Insured receives notice of the adverse benefit decision. Only one appeal is allowed. As part of the appeal process, the Insured will: (1) Be provided with the opportunity to send us written comments, documents, records, and other information related to the Insured’s claim for benefits in conjunction with the Insured’s timely appeal; and (2) Be provided, upon request and free of charge, reasonable access to, and copies of, all non-privileged documents, records, and other information relating to the Insured’s claim for benefits. We will review the Insured’s appeal promptly after receiving the Insured’s request. We will advise the Insured of the results of our review within 45 days after we receive the Insured’s timely request for review, unless it is determined that special circumstances require an extension of time for processing the appeal. If it is determined that an extension of time for processing is required, we will give the Insured written notice of the extension prior to the termination of the initial 45- day period. In no event will such extension exceed a period of 45 days from the end of the initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date by which the determination on review is expected to be made. The period of time within which a benefit determination on review is required to be made shall begin at the time an appeal is timely filed, without regard to whether all the information necessary to make a benefit determination accompanies the filing. In the event that a period of time is extended as described above due to the Insured’s failure to submit information necessary to decide the claim, the period for making the benefit determination on review shall be tolled from the date on which the notification of the extension is sent to the Insured until the date on which the Insured responds to the request for additional information. Our decision on the Insured’s appeal will be in writing and will include the specific reason or reasons for the decision and reference to specific plan/Policy provisions on which the decision was based. For any adverse benefit decision on the Insured’s appeal, our notice will also include: (1) A statement that the Insured 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 Insured’s claim for benefits; (2) A description of the Insured’s right to bring a civil action under section 502(a) of the Employee Retirement Income Security Act of 1974 as amended ("ERISA") (where applicable), as well as a description of any applicable contractual limitations period that applies to the Insured’s right to bring such an action, including the calendar date on which the contractual limitations period expires for the claim; (3) A discussion of the decision, including an explanation of the basis for disagreeing with or not following: a. The views presented by the Insured to the plan of health care professionals treating the Insured and vocational professionals who evaluated the Insured; b. The views of medical or vocational experts whose advice was obtained on behalf of the plan in connection with the Insured’s adverse benefit decision, without regard to whether the advice was relied upon in making the benefit decision; and c. A disability determination regarding the Insured made by the Social Security Administration; and (4) Either the specific internal rules, guidelines, protocols, standards or other similar criteria of the plan that we relied upon in making the adverse decision, or, alternatively, a statement that such rules, guidelines, protocols, standards or other similar criteria of the plan do not exist; and (5) A statement that the Insured is entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to a claim for benefits. The notification will be provided in a culturally and linguistically appropriate manner. ARBITRATION OF CLAIMS: Any claim or dispute arising from or relating to our determination regarding the Insured’s Total Disability may be settled by arbitration when agreed to by the Insured and us in accordance with the Rules for Health and Accident Claims of the American Arbitration Association or by any other method agreeable to the Insured and LRS-6564-6-0719-IN Page 6.3