Appealing A Denied Claim 

If your claim is denied in whole or in part, you will receive written notification within 60 days after you filed your claim. This notice will include the specific reasons for the decision, the Plan provisions on which the decision is based, any information needed to complete the claim and the reasons why this informa­tion is needed.  The notice will also explain the Plan’s claim review procedures. 

You may file a written appeal to the Fund Administrator within 90 days of the date of the notice of denial. You or your representative has the right to review and request copies (free of charge) of pertinent Plan documents and to submit in support of your claim a written statement, documents, records and other information relating to your claim.  The Fund Administrator will take into account everything that you submit in support of your claim and will respond with a written notice within 60 days of receiving your appeal, stating whether the appeal is approved or denied.  This notification will include the specific reasons for the decision, the Plan provisions on which the decision is based, the information needed to complete the claim, and the reasons why this informa­tion is needed.  The notice will also explain the Plan’s claim review procedures.

If you are not satisfied with the Fund Administrator’s decision regarding your claim appeal, you may request a review of the Fund Administrator’s denial within 60 days after you receive the administrator's determination.  The review will take place at the next regularly scheduled Board of Trustees meeting if possible.  However, the review must take place within 120 days after it receives your written request for a review.  If you have not already done so, you or your representative has the right to review and request copies (free of charge) of Plan documents, records and other information pertinent to your claim.  You may also submit in support of your claim a written statement, documents, records and other information relating to your claim.  However, the Board of Trustees has discretionary power and authority to make benefit eligibility determinations, to construe the terms of the Plan, and to determine your rights under the Plan.  Its decisions are entitled to the maximum deference permitted by law.  The Board’s decision on your appeal will be made in writing and is final and binding.  The Board will take into account everything that you submit in support of your claim and will respond with a written notice no more than five days after making its determination, stating whether the appeal is approved or denied.  This notification will include the specific reasons for the decision and the Plan provisions on which the decision is based.