2003-01-08 CC Packet - Laserfiche WebLink

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decision will not be made by the person who initially denied the claim or a subordinate of that person. If a medical expert is consulted in connection with the appeal, he or she will be different from (and will not be a subordinate of) any expert consulted in connection with the initial claim denial and his or her identity will be provided. If the initial denial of the claim is affirmed on review, the Participant will be furnished with a notice of adverse benefit determination on review setting forth (1) the specific reasons for the decision on review, (2) the specific provisions of the Plan on which the decision is based, (3) a statement of the Participant's right to review (on request and at no charge) relevant documents and other information, and (4) if an internal rule, guideline, protocol or other similar criterion was relied on in making the decision on review, a description of the special rule or a statement that such a rule was relied on and that a copy of the rule will be provided to the Participant free of charge upon request. A Participant may choose to have legal counselor another representative represent the Participant in the claims procedure. The Employer may require proof that the individual is authorized to act ofthe Participant's behalf. Participants must follow this claims procedure for any claims under the Plan, and the failure to do so may prevent the Participant from challenging an adverse decision in court. This claims procedure may be modified in accordance with Section 8.1 in the event of changes to the applicable laws and regulations. Article VII. Administration and Finances Section 7.1 Administration. The Employer shall be the administrator of the Plan, and, as such, has total and complete discretionary authority to determine conclusively for all parties all questions arising in the administration of the Plan. The Employer shall have all powers necessary to administer the Plan, including, without limitation, powers: (a) to interpret the provisions ofthe Plan; (b) to establish and revise the method of accounting for the Plan and to maintain the accounts; (c) to establish rules for the administration of the Plan and to prescribe any forms required to administer the Plan; and (d) to change plans, contracts or policies and/or insurers or other providers of benefits described in Sections 5.2 of the Plan. 21