MY
BENEFITS
CENTER

Claims Review

Every effort will be made to complete the processing of all applications for Pension Benefits within 90 days after receipt by the Fund Office, or 45 days in situations involving applications for Disability Pensions. This period will begin upon receipt of your signed application form by the Fund Office without regard to whether all of the additional information necessary to decide the application has been submitted. Other periods of time set forth in this Section governing Claims and Appeals Procedures shall begin to run on the date the Plan first receives written notice of a claim or appeal.

In the event a decision on your benefit application cannot be made within the above processing period following receipt of your application, a letter will be sent to you prior to the expiration of the 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, as well as any additional information necessary for you to complete your appeal. In no event shall such extension exceed a period of 90 days from the end of the initial period.

If your application for Pension Benefits is denied in whole or in part, 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 plan provisions on which the determination was based;
• a description of any additional material or information necessary for you to perfect the claim and an explanation of why such material or information is necessary;
• a description of the plan’s review 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, and
• any other information necessary for you to perfect your appeal.

If your application for Disability Pension Benefits is denied in whole or in part based on a determination by the Fund (and not by a third party such as the Social Security Administration) that you are not disabled under the Fund rules, in addition to the items listed above, the written notice you will receive from the Fund Office will include:

• an explanation of the Fund’s basis for disagreeing with or not following: the views you presented to the Fund of health care professionals treating you and vocational professionals who evaluated you (if any); the views of any medical or vocational experts whose advice was obtained on behalf of the Fund in connection with the denial of your claim (even if the advice was not relied upon in making the determination); and a disability determination made by the Social Security Administration (if you provided it to the Fund);
• the specific internal rules, guidelines, protocols, standards, or other similar criteria of the Fund relied upon in making the adverse benefit determination or, alternatively, a statement that such rules, guidelines, protocols, standards, or other similar criteria of the Fund do not exist;
• a statement that you are entitled to receive, upon request, and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to your claim for benefits.

Appealing A Denied Claim or Disagreeing With an Action

If you receive a notice that your claim for Pension Benefits has been denied, you may submit a written appeal to the Trustees requesting that the Board of Trustees review your benefit denial.

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

• Pension Benefit Claims in General — Your written appeal must be submitted within 60 days of receiving the notice of denial of benefits (other than disability benefits).
• Disability Pension Claims — Your written appeal must be submitted within 180 days of receiving the notice of denial of Disability Pension benefits.

You will be entitled to a full and fair review. Your written appeal should state clearly why you believe you are entitled to the benefit you claim, or why you disagree with the Plan’s determination.

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.

On appeal, the Board of Trustees will render a decision by the date of the next quarterly Trustees’ meeting, but if the appeal is received less than 30 days prior to the next quarterly meeting, then a decision will be rendered no later than the second quarterly Trustees’ meeting after the appeal is received. If special circumstances arise which require an extension of time to make a decision on appeal, such as the need for additional information, then the Trustees will provide written notice of the need for the extension to the participant or beneficiary, and will decide the appeal no later than the next following quarterly Trustees’ meeting. In the event an extension of time is required based on the need for additional information, the time for making a determination on appeal shall be tolled until the additional information is received by the Fund Office. Once a decision on appeal is rendered, the Fund Office will notify you of the Trustees’ decision as soon as administratively feasible, but, in any event, not longer than five (5) days after the decision is reached.

When the Board of Trustees decides a disability benefit appeal that involves a medical judgment, it will consult with a health care professional who has appropriate training and expertise in the field of medicine upon which the Plan’s initial determination was based. This medical professional will not be the person who was consulted in connection with the adverse determination that is the subject of the appeal, nor his or her subordinate. In their decision, the Trustees or committee will identify all medical expert(s) whose advice was obtained by the Plan in connection with the claim without regard to whether the advice was relied upon in making the benefit determination or decision on appeal.

Prior to issuing an appeal denial for a disability pension claim that is denied in whole or in part based on a determination by the Fund (and not by a third party such as the Social Security Administration) that you are not disabled under the Fund rules, the Board of Trustees will provide you, free of charge, with any new or additional evidence considered, relied upon, or generated by the Plan in connection with the claim, and/or with any new or additional rationale for denying the claim. This information will be provided to you as soon as possible in advance of the date your appeal is to be considered to give you a reasonable opportunity to respond prior to a decision being made regarding your appeal. 

If your appeal is denied in whole or in part, 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 plan provisions on which the determination was based;
• A statement that you are entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records and other information relevant to your claim for benefits;
• A statement describing any voluntary appeal procedures offered by the Plan, if any, and your right to obtain the information about such procedures including a statement of your right to bring a civil action under Section 502(a) of ERISA following an adverse benefit determination on review. In the case of a denial of a Disability Pension Benefit appeal, the statement of your right to bring an action under Section 502(a) of ERISA will also describe any contractual limitations period that applies to your right to bring such an action, including the calendar date on which the contractual limitations period expires for the claim.

If your Disability Pension Benefit appeal is denied in whole or in part based on a determination by the Fund (and not by a third party such as the Social Security Administration) that you are not disabled under the Fund rules, in addition to the items listed above, the written notice you will receive from the Fund Office also will include:

• an explanation of the Fund’s basis for disagreeing with or not following: the views you presented to the Fund of health care professionals treating you and vocational professionals who evaluated you (if any); the views of any medical or vocational experts whose advice was obtained on behalf of the Fund in connection with the denial of your claim (even if the advice was not relied upon in making the determination); and a disability determination made by the Social Security Administration (if you provided it to the Fund);
• a statement that you have a right to know the identity of any medical or vocational expert consulted in making a determination on your appeal, if your appeal is denied on the basis of a medical judgment.

You may renew your appeal if you have any new information or arguments to present. A renewed appeal must be submitted in writing within the original above-stated time frames for submitting an appeal. In connection with an appeal or a renewed appeal, you may review relevant documents relating to your appeal 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.

In the application and interpretation of the Plan, the decision of the Trustees shall be final and binding on all parties, including employees, employers, the Union, participants, claimants and beneficiaries or their representatives.

To the extent permitted by these claims procedures, you must furnish to the Trustees any information or proof requested and reasonably required to administer the Plan.