Summary Plan Description

Benefit Claim Review Procedures

If your claim for benefits has been either denied or partially denied, you have 60 days after the receipt of the written notification of the denial to appeal the denial by requesting the Board of Trustees, in writing filed with the Fund Office, to review your claim.

Ordinarily, the Board of Trustees will designate a Hearing Panel to review your claim as soon as possible after the receipt of your written request for a review, and will notify you in writing of the date, time and place of the hearing.

The Hearing Panel will review your claim along with any additional information which either you or your representative wish to present to the Hearing Panel. In preparation for this hearing, you have the right to review all documents and other papers held by the Plan which affect your claim. You have the right to argue against the claim denial either orally, or by submitting issues or comments in writing. You also have the right to have a representative act, at your own expense, on your behalf if you wish. The appeal before the Hearing Panel is informal in nature and a written transcript of the proceeding will not be taken.

The Board of Trustees, after reviewing the report of the Hearing Panel, shall make a decision in writing within 60 days after the receipt of the request for review which reaffirms, modifies or sets aside the former denial or partial denial. In special cases, including the holding of a hearing, more time (up to 60 more days from the date of the receipt of the request for review) may be needed to make the decision on review. In such a case, you will be notified that there will be a delay, along with an explanation of the reasons for needing more time.

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