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Appealing a Denied Claim
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If your claim for any benefit is denied, in whole or in part, or if you dispute
whether or not you are eligible to participate in any program under the Fund,
you may file a written appeal to the Fund Administrator within 90 days of the
date of the notice of denial. The Fund
Administrator will respond with a written notice within 60 days of receipt of
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.
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 the Board receives your written request for a review.
You or your representative has the right to
review pertinent Plan documents and submit a written statement in support of
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.
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