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Individual Account Retirement Plan – Appeals

If the Plan denies your application for benefits, in whole or in part, you will be notified in writing of the determination and be given the opportunity for a full and fair review of the benefit decision. The written notice of denial will include:

  • The specific reason(s) for the denial;
  • reference to the specific Plan provision(s) on which the denial is based;
  • A description of any additional material or information necessary for you to perfect your claim and an explanation of why such material or information is necessary;
  • A description of the Plan’s review procedures and the time limits applicable to such procedures, including a statement of your rights to bring civil action under §502(a) of ERISA following an adverse benefit determination on review.

If your claim is denied, or if you believe that you did not receive the full amount of benefits to which you are entitled, you have the right to petition the Board of Trustees for reconsideration of its decision.   Your appeal must be in writing and filed within 60 days from the date of your denial letter. Failure to file your appeal within 60 days will constitute a waiver of your right to appeal. Please note that there is no particular form to use in filing an appeal of a benefits denial. You have the right to appoint in writing an authorized representative to act on your behalf in pursuing your claims appeal.

Your request for appeal must be in writing and state in clear and concise terms the specific items in your denial that you believe to be incorrect or incomplete. You may include any documents, records and other information related to the claim for benefits that you believe may support your case. A late application may be considered if the Board of Trustees finds that the delay in filing was for reasonable causes.

Upon request, you will be provided, free of charge, reasonable access to and copies of all documents, records, and other information relevant to your claim for benefits if they (1) were relied upon in making the claims decision, (2) were submitted, considered or created in the course of making the benefit determination even if not relied upon, (3) demonstrate that the Plan provisions have been followed and applied consistently with respect to cases involving similar circumstances, or (4) constitute a statement or policy or guidance with respect to the Plan concerning the denied benefit whether or not relied upon.

Review of your appeal will take into account all comments, documents, records and other information submitted by you regardless of whether such information was submitted in connection with your original claim. You do not have a right to appear before the Board of Trustees or appeals committee of the Board, unless the Board concludes that such an appearance would be of value in enabling it to review the original denial of benefits.

A properly filed appeal will be reviewed by the Board of Trustees (or by a committee authorized to act on behalf of the Board of Trustees) at its next regularly scheduled quarterly meeting. However, if the appeal is received within 30 days prior to such meeting, the appeal may be reviewed at the second quarterly meeting following the receipt of your appeal. If special circumstances require an extension of time, the Board of Trustees or committee will render a decision at the third scheduled quarterly meeting following the receipt of your appeal. The Fund Office will notify you, in writing, before the beginning of the extension of the special circumstances and the date that the Board of Trustees will make its decision.

The Board of Trustees will review all submitted comments, documents, records and other information related to your claim, regardless of whether the information was submitted or considered in the initial benefit determination. The Board of Trustees will not give deference to the initial adverse benefit determination.

You will receive written notification of the benefit determination on an appeal no later than 5 days after the benefit determination is made.  In the case of an adverse benefit determination on the appeal, the written denial will include:

  • The reason(s) for the determination;
  • References to the specific Plan provisions on which the determination 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 for benefits.
  • A statement of your right to bring a court action under ERISA § 502(a).

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 Board of Trustees’ decision was an abuse of discretion in light of the information available to it at the time of its decision.