Pension Plan – Appeals

Appeals Procedures

If your application for benefits is denied or you believe that you are not receiving all benefits to which you are entitled, you may have your case reviewed by the Board of Trustees or a Subcommittee of the Board of Trustees by following the claims and appeals procedures described below. Note that they detail both the obligations of the Plan to provide an avenue for your appeal, as well as your responsibilities in presenting your case.

Claim Filing

All initial claims must be filed with the Fund Office in written form or electronically using such forms or standards as the Joint Board may specify from time to time. Typically, this rule is satisfied by filing an application obtained from the Fund Office. If your claim does not contain all the necessary information, including information required from the Social Security Administration, the Fund Office will notify you or your authorized representative in written or electronic form as soon as possible.

Initial Claim Denial

The Fund Office shall notify you of any denial of benefits within a reasonable period of time, but not later than 90 days after receipt of your claim.^[2]

If the Fund Office determines that there is not sufficient information to determine the claim within this time frame, it will notify you prior to the expiration of the time limit of the circumstances requiring the extension and the date by which a decision is expected to be rendered. The initial time period for a decision can then be extended for up to an additional 90 days.

If you do not hear from the Fund Office within the above time frame, you may proceed to the appeal procedure as if the claim were denied.

If the Fund Office denies your claim, it will notify you by letter or electronic form written in a manner calculated to be understood by you. The letter will contain the following information.

The specific reason or reasons for the decision.
Reference to the specific Plan provision on which the decision is 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 procedure and the time limits applicable to such procedures.
A statement of your right to bring a court action under ERISA Section 502(a) following an adverse decision on review.

[2] The time period from which a benefit determination is to be made begins at the time a claim is filed without regard to whether all the information necessary to make a benefit determination accompanies the filing. If the period of time is extended as provided for later in this section, the period for making the benefit determination shall be tolled from the date on which the notification of extension is sent to you until the date on which you or other entity supplying the information (such as the Social Security Administration) responds to the request for additional information.

Appealing a Claim Denial

If your claim is denied in whole or in part and you wish to appeal, you must file with the Joint Board an appeal in writing within 60 days following receipt of the Plan notification of an adverse initial determination. There is no specific form for this purpose. Late applications may be considered by the Board of Trustees in its sole discretion if it finds that the delay in filing was reasonable under the circumstances. Failure to file an appeal within the designated period will constitute a waiver of your right to review the denial of his claim whether or not the Plan is prejudiced by the failure.

You may submit written comments, documents, records or other information relating to the claim.

Upon written request, you will be provided, free of charge, reasonable access to and copies of any documents, records and other information if they:

Were relied upon in making the initial determination,
Were submitted, considered or generated in the course of making the benefit determination even if not relied upon,
Demonstrate that the Plan provisions have been followed and applied consistently with respect to similarly situated individuals, or
Constitute a statement of policy or guidance with respect to the Plan concerning the denied benefit whether or not relied upon.

The appeal will take into account all comments, documents, records, and other information submitted by you relating to the claim, without regard to whether such information was submitted or considered in the initial determination.

You shall have no right to personally appear before the Board of Trustees, unless the Board in its sole discretion concludes than such an appearance would be of value in enabling it to review the adverse initial determination.

Decision on Appeal

In general, the Board of Trustees decides appeals at the next regularly scheduled meeting. However, if the appeal is received within 30 days preceding the date of such meeting, the appeal may be tabled and decided by no later than the date of the second meeting following receipt of the appeal.^[3]

The Fund Office shall notify you by written or electronic means of the Board of Trustees’ decision as soon as possible, but not later than 5 days after the appeal is decided. If the decision is a denial, it shall be communicated to in a manner calculated to be understood by you and include the following information:

The specific reason or reasons for the decision.
Reference to the specific Plan provisions on which the appeal is 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.
A statement of your right to bring a court action under ERISA Section 502(a).

Following issuance of the decision on your appeal, you have no further right under these procedures to appeal or arbitrate the decision.

[3] The time period from which an appeal is to be made begins at the time the appeal is filed without regard to whether all the information necessary to make a benefit determination accompanies the filing. If the period of time is extended as hereafter provided, the period for deciding the appeal shall be tolled from the date on which the notification of extension is sent to Claimant until the date on which the Claimant responds to the request for additional information.

Legal Proceedings

You may pursue your claim for benefits in court under ERISA Section 502(a) but only after you have exhausted your administrative remedies as provided in these claims procedures. Your failure to exhaust your administrative remedies will preclude further judicial review.

The Board of Trustees is given full discretionary authority (1) to finally determine all facts relevant to any claim, (2) to finally construe the terms of the Plan and all other documents relevant to the Plan, and (3) to finally determine what benefits are payable from the Plan.

Any decision made by the Board of Trustees or its appointed subcommittee shall be binding on all persons affected to the fullest extent permitted by law.

No decision of the Board of Trustees shall be revised, changed or modified by any arbitrator or court unless the party seeking such action is able to show by clear and convincing evidence that the Joint Board’s decision was an abuse of discretion in light of the information actually available to it at the time of its decision.

Miscellaneous Provisions

You may appoint in writing an authorized representative to act on your behalf in pursuing a claim or appeal under these claim procedures. There is no required form for this purpose.

The Fund Office shall maintain records designed to ensure and verify that determinations are made in accordance with Plan documents and that, where appropriate, the Plan provisions have been applied consistently with respect to similarly situated claimants. Plan participants’ privacy will be protected at all times.

Any decisions affecting your benefits under the Plan may be appealed under these claims procedures, including:

A denial, reduction or termination of any Plan benefit.
A failure to provide or make payment in whole or in part for any Plan benefit.
A refusal to provide a Plan benefit based on a determination that the Claimant is not eligible under the terms of the Plan.

The Board of Trustees retains the right to interpret and amend these Claims Procedures. Furthermore, if these procedures are ambiguous or do not provide an explicit procedure for a specific circumstance, the Board of Trustees is authorized to adopt such rules as it in its discretion deems necessary and appropriate to provide claimants with appropriate initial determinations and an opportunity for a full and fair review of any adverse benefit determination.