You or your authorized representative may file a written appeal with the Fund Office no later than 90 days (180 days in the case of a disability application) after you receive notice that your application for benefits has been denied. You also have a right to review pertinent documents and to submit comments in writing.
A Participant has 90 days following a claim denial within which to appeal to the Board of Trustees. The appeal must be in writing and shall set forth all facts and include all documents necessary to support the appeal. Failure to file a timely appeal shall be a bar to your ability to appeal or challenge a denial of a benefit under the Plan.
If the Participant or Beneficiary fails to appeal or request such a review to the Plan Administrator in writing within the prescribed period of time, the Plan Administrator’s adverse determination shall be final, binding and conclusive.
Prior to filing a lawsuit challenging an adverse benefit decision, you must first exhaust your administrative remedies set forth in the Plan, including filing a timely appeal. Suit may be filed in state or federal court and must be filed within one year from the date your appeal was denied. The mailbox rule shall apply in determining the date the appeal was denied. A failure to file suit within one year following the date your appeal was denied shall be a bar to any recovery.
- Submit additional materials, including comments, statements or documents; and
- Request to review all relevant information (free of charge).
In addition, when filing an appeal for a distribution due to a disability:
- You have the right to be advised of the identity of any medical experts.
- If the determination was based on an internal rule, guideline, protocol or other similar criteria, you have the right to request a free copy of such information.
- If the determination was based on a medical necessity, experimental treatment or similar exclusion or limit, you have the right to request a free copy of an explanation of the scientific or clinical judgment for the determination.
- If the determination is based on medical necessity or appropriateness, the Annuity Plan must consult a medical professional who is not the same individual who consulted on the initial review of the application or a subordinate of that individual.