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Claim Review Procedure

Should you be denied benefits by Plan Counsel and disagree with this decision, there is a process that must be followed by you (or your authorized representative). First, Plan Counsel is required to provide in writing, within ten (10) days of the date the claim for benefits was filed, the specific reason(s) for denying benefits in a clear and concise manner including the specific Plan provision upon which the denial is based. This letter must also state your right to contest this claim denial within sixty (60) days of the written notification.

Next, the claimant must write a letter directed to the Fund Coordinator requesting a review of denial by the Case Review Committee. The purpose of this committee is to carry out a full and fair review of the claim denied. A decision on the review shall be made no later than the next regularly scheduled Trustees’ meeting if the request for review is received within thirty (30) days preceding the date of such meeting. Where applicable, a decision shall be made no later than the date of the second meeting following receipt of the request for review. Special circumstances may require an extension of time for processing but it should be reached no later than the third meeting following receipt of the request for review.

The Case Review Committee’s decision shall be final and binding on all parties and will be decided on the basis of the documentation and the merits of the case.

The decision of this committee shall be in writing and rendered no later than ten (10) days following the meeting when the claim was reviewed. At that time, if the claim is denied, the letter will include specific reasons for the denial.

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