Claim Review Procedure

If any claim for benefits is denied in whole or in part, the Fund Office will give notice of such denial within ninety (90) days of receipt of claim.  The written denial will state, in a manner deemed to be understood by you, the specific reason for the denial; the specific Plan provisions on which the denial is based; additional information necessary, if any, for you to perfect the claim and an explanation of the need for that information and a description of the steps you may take to request a review of the decision.

You may submit a written request to the Fund Office for review of the claim denial within sixty (60) days of your receipt of the notice of denial.  You have the right to review any applicable Plan documents and to request a personal appearance before the Trustees to present your case.

The Trustees will review your appeal during the next regularly scheduled Trustee’s Meeting, unless your appeal is received less than thirty (30) days prior to that meeting.  In this case, the appeal will be considered during the second regular Trustees’ Meeting following receipt of your appeal.  If special circumstances exist requiring an extension of time for processing the appeal or obtaining more information, you will be so notified, however a determination will be made no later than the next following meeting and you will be advised of the date of that meeting.  On any appeal to the Trustees, you have the right to be present together with a representative of your choosing, at your expense.  Notice of a determination made during the quarterly Trustees’ Meeting will be provided to you in writing within five (5) days following the decision.  This decision will set out the specific reasons for the decision and provide specific reference to the pertinent Plan provisions on which the decision is based.

The decision of the Trustees on review will be made in good faith and will be final and binding on all issues.  Claimant or claimant’s duly authorized representative will be required to exhaust the entire Claim Review Procedure before instituting any other form of action.  Decisions on request for reviews involving terms of the Plan, such as the eligibility rules, will also be made by the Board of Trustees.