review shall be tolled from the date on which the notification of the extension is sent to the claimant until the date on which the claimant responds to the request for additional information. MANNER AND CONTENT OF NOTIFICATION OF BENEFIT DETERMINATION ON REVIEW Non-Disability Benefit Claims A claimant shall be provided with written notification of the benefit determination on review. In the case of an Adverse Benefit Determination on Review, the notification shall set forth, in a manner calculated to be understood by the claimant, the following: 1. The specific reason or reasons for the adverse determination; 2. Reference to the specific plan/policy provisions on which the determination is based; 3. 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 (defined below) to the claimant’s claim for benefits; and 4. A statement of the claimant’s right to bring an action under section 502(a) of ERISA (where applicable). Disability Benefit Claims A claimant must be provided with written notification of the determination on review. In the case of Adverse Benefit Determination on Review, the notification shall set forth, in a manner calculated to be understood by the claimant, the following: 1. The specific reason or reasons for the adverse determination; 2. Reference to the specific plan/policy provisions on which the determination is based; 3. 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 (defined below) to the claimant’s claim for benefits; 4. A statement of the claimant’s right to bring an action under section 502(a) of ERISA (where applicable) as well as a description of any applicable contractual limitations period that applies to the claimant’s right to bring such an action, including the calendar date on which the contractual limitations period expires for the claim; 5. A discussion of the decision, including an explanation of the basis for disagreeing with or not following: a) The views presented by the claimant to the plan of health care professionals treating the claimant and vocational professionals who evaluated the claimant; b) The views of medical or vocational experts whose advice was obtained on behalf of the plan in connection with a claimant's Adverse Benefit Determination, without regard to whether the advice was relied upon in making the benefit determination; and c) A disability determination regarding the claimant presented by the claimant to the plan made by the Social Security Administration; 6. 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; 7. 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 (defined below) to a claim for benefits; and 8. The notification shall be provided in a Culturally and Linguistically Appropriate (defined below) manner. REQUESTS CONCERNING ALLEGED VIOLATION OF THESE PROCEDURES In the event that a claimant requests a written explanation of any alleged violation of these procedures, such explanation should be provided within 10 days, including a specific description of any basis for asserting that any violation should not cause any administrative remedies available under the plan to be exhausted (where applicable). DEFINITIONS The term "Adverse Benefit Determination" means any of the following: a denial, reduction, or termination of, or a failure to provide or make payment (in whole or in part) for, a benefit, including any such denial, reduction, termination, or failure to provide or make payment that is based on a determination of a participant’s or beneficiary’s eligibility to participate in a plan.
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