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Manual of Benefits
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COMET MARKETS |
| APPEALS PROCEDURE When the claim of a Plan participant or beneficiary (hereinafter referred to as "claimant") is processed, it shall initially be the responsibility of the Administrator of the Fund to decide what benefits the claimant is entitled to, in accordance with the benefits provided by the Plan. In the event that the claim is partially or totally denied, the claimant shall, within a reasonable amount of time, be advised in writing by the Administrator of the reasons for said denial with specific references to pertinent plan provisions and shall be given a copy of this Appeals Procedure. The claimant shall also be given a description of any additional material or information necessary for the claim to be honored and an explanation of why such information or material is necessary. Said information shall be provided in a manner calculated to be understood by the claimant. If the claimant desires to appeal the said denial of the benefit, he or she shall communicate said desire to appeal to the Administrator of the Fund within sixty (60) days of receipt of the written notice of denial. No special form of appeal is necessary, but said appeal shall be made in writing. The administrator of the Fund shall refer the appeal to the Board of Trustees. The Board of Trustees shall, if possible, hear the appeal at its next regular meeting, or at a specifically convened meeting. The Board of Trustees may delegate the hearing of the appeal to a panel consisting of one or more Trustees. The Appellant may review pertinent documents and submit issues and comments in writing to the Board of Trustees. The Appellant also has the right to be represented by counsel, of his own choosing and at his own expense, at the hearing before the Board of Trustees, or its designee, if he so desires. He has the right to testify, to produce witnesses and documentary evidence, and to cross-examine witnesses. The Board of Trustees shall communicate its decision in writing to the Appellant not later than one hundred and twenty days after the request for review of the denial of the claim. The decision shall include the specific reasons for the decision and specific references to the pertinent plan provisions upon which the decision is based. The decision of the Board of Trustees (subject to the terms and conditions described in the Group Policy) shall be final and binding in the matter of the appeal. The Plan's Fiscal Year ends on: June 30 The Plan's Employer Identification Number is: 23-6487659 In addition to Plan Counsel acting as agent for the service process, the Administrator and all Trustees will serve in this capacity as well. The Plan is maintained pursuant to a Collective Bargaining Agreement. Copies of the Agreement are available upon written request to the Administrator within thirty (30) days. All participants are entitled to a copy of a list of all contributing employers and can obtain such within thirty (30) days by sending a written request to the Administrator. Both the Bargaining Agreement and the list of participating employers are also available for inspection at the office of the Administrator. |