Appealing a Denied Claim
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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