MY
BENEFITS
CENTER

Notification of Initial Benefit Determination

Every effort will be made to complete the processing of all applications within 90 days after receipt by the Fund Office. This 90-day period will begin upon receipt of your signed application form by the Fund Office without regard to whether all of the information necessary to decide the application has been submitted.

In the event a decision on your benefit application cannot be made within 90 days of receipt of such application, a letter will be sent to you prior to the expiration of the 90-day period explaining the special circumstances requiring an extension of time to take action on your application. The letter will also include the date by which a decision is expected to be reached (not to exceed an additional 90-day period).

Appealing a Denied Claim (“Adverse Benefit Determination”) or Disagreeing with an Action

In General
If your application for benefits is denied in whole or in part or you otherwise receive an adverse benefit determination, the Fund Office will provide you with a written or electronic notice that sets forth:

• the reasons for the adverse benefit determination;
• references to any pertinent Plan provisions, internal rules, guidelines, protocols or other criteria relied on in making the adverse determination;
• a description of any additional materials or information which might help your claim (including an explanation of why that information may be helpful); and
• a description of the appeals procedures and applicable filing deadlines including a statement of your right to bring a civil action under Section 502(a) of ERISA following an adverse benefit determination on review.

Definition of Adverse Benefit Determination
An adverse benefit determination is any of the following: A denial, reduction, or termination of, or a failure to provide or make payment (in whole or in part) for, a benefit, including any such denial, reduction, termination, or failure to provide or make payment that is based on a determination of your eligibility to participate in the Plan.

Appeal Procedures

If you receive such a notice, or if you disagree with a policy, determination or action of the Plan that is not an adverse benefit determination as defined above, you may submit a written appeal to the Trustees requesting that the Board of Trustees review your benefit denial or the Fund policy, determination or action with which you disagree.

The time you have to appeal to the Trustees will depend on the type of claim denied:

• Benefit Claims in General. Your written appeal must be submitted within 120 days of receiving the notice of denial of benefits.
• Disagreement Regarding a Fund Policy, Determination or Action other than a Benefit Claim. Your written appeal must be submitted within 60 days after you learn of a Fund policy, determination or action with which you disagree and which is not an adverse benefit determination.

Your written appeal should state the reason for your appeal. This does not mean that you are required to cite all applicable Plan provisions or make “legal” arguments; however, you should state clearly why you believe you are entitled to the benefit you claim, or why you disagree with a Fund policy, determination or action.
You are permitted to submit written comments, documents, records and other information relating to your claim even if such information was not submitted in connection with your initial claim for benefits. The Trustees can best consider your position if they clearly understand your claims, reasons and/or objections.
The Trustees or a designated committee of Trustees will review your appeal and render their decision within a reasonable period of time but no later than 60 days after their receipt of your written appeal. If special circumstances require additional time, the Trustees or a designated committee of Trustees may render their decision within 120 days after receipt of the appeal. If an extension is needed for the Plan to process your appeal, the Fund Office will provide written notice of the delay and state the reason(s) why the extension is necessary.

Notification on Appeal

Once your claim has been reviewed and a benefit determination has been made, you will receive written or electronic notice of the decision. The notice will explain the reasons for the decision, include specific references to Plan provisions, internal rules, guidelines, protocols or other criteria on which the decision is based and may state whether additional information may help your claim. Additionally, the notice will indicate that you are entitled to request access to documents, records, and other information relevant to your claim for benefits.

You may renew your appeal if you have any additional information or arguments to present. A renewed appeal must be submitted in writing, and the rules and limits stated above apply. In connection with an appeal or a renewed appeal, you may review relevant documents in the Fund Office after making appropriate arrangements, or you may request that documents be provided to you. This information will be provided free of charge.

Trustees’ Decision on Appeal is Final and Binding

The Trustees have full discretion or authority to determine all matters relating to the benefits provided under this Plan including, but not limited to, all questions of eligibility. If the Trustees deny your appeal of a claim, and you decide to seek judicial review, the Trustees’ decision is subject to limited judicial review to determine only whether the decision was arbitrary and capricious.