The Board of Trustees will decide if you meet the eligibility requirements for a pension. The Trustees are bound by the rules of the Pension Plan and are the sole judges in interpreting the Plan and determining eligibility based on the documents you submit with your application.
Generally, you will receive a written confirmation of the approval or denial of a claim for any type of benefit other than a Disability Pension within 90 days after the claim has been received by the Plan. (See Claim Determination for more information about benefit determination for Disability Pensions.) If additional time is required in special cases, you will be notified in writing of the special circumstances requiring an extension of time and of the date by which the Plan expects to make final decision on the claim. The extension of time to decide a claim is 90 days so the maximum processing time is 180 days (the initial 90 days plus one 90-day extension). If the Plan needs an extension of time, you will be given a written notice of the extension before the end of the initial 90-day period.
If the Plan needs additional information or material to process your disability claim and if the Plan requests that material in writing, you will be given up to an additional 90 days to obtain the information the Plan has asked you to provide. The time for the Plan to decide your claim is extended by the time it
takes you to provide the requested information. When you respond to the Plan’s request for additional information, the ordinary time limits (the 45-day period or the 30-day extension) will again start to run. If you do not respond to the Plan’s request within 90 days, the Plan will decide without that information, which may result in the denial of your claim.
If Your Application Is Denied
If your claim is denied, in whole or in part, you will receive a written notice that will include:
- The specific reason(s) for the denial.
- Reference to specific Plan provisions on which the denial was based.
- A description of additional information needed to reconsider your application and why the information is necessary.
- A detailed explanation of the Plan’s appeal procedures, along with time limits for filing an appeal.
- A statement that you have the right to bring a civil action under ERISA following an appeal.
- For a denial of an application for benefits due to disability, a statement that:
– You have the right to request a copy, free of charge, of any internal rule,
guideline, protocol, or similar criteria upon which the denial was based.
– You have the right to request a copy, free of charge, of any medical judgment, including an explanation regarding the scientific or clinical judgment, upon which the denial was based.
If your application for benefits is denied in whole or in part, or your pension payments are suspended or stopped for any reason, you may request a full and fair review by filing a written notice of appeal with the Fund Office. The Fund Office must receive a notice of appeal no later than 60 days (180 days for a disability claim) after you receive written notification of your denied claim or, if applicable, suspension of your pension. Your appeal is considered to have been filed on the date the written notice of appeal is received by the Fund Office.
If you like, another person may represent you in connection with an appeal. If you use an authorized representative to represent you in your appeal, the Trustees have the right to require that you give the Plan a signed statement, advising the Trustees that you have authorized that person to act on your behalf regarding your appeal. Any representation by another person will be at your own expense. In connection with your appeal, you or your authorized representative may review pertinent documents and may submit issues and comments in writing.
If you appeal your application or benefit amount, the Board of Trustees will complete a new full and fair review of your application based on all the information available. The members of the Appeals Committee who initially denied your claim for benefits will not vote again when the full Board considers your appeal. The Trustees hold regular meetings at least four times per year. If you file your appeal:
- More than 30 days before a regular Board of Trustees meeting, the Trustees will make a decision at that meeting unless special circumstances require an extension of time for processing. In that case, the Trustees will make a decision on your appeal at the following meeting.
- Within the 30-day period immediately preceding a regular Board of Trustees meeting, the Trustees will make a decision at the following meeting, unless special circumstances require an extension of time for processing your appeal. In that case, the Trustees will make a decision on your appeal at the third regular meeting following the date your appeal was filed.
Whenever there are special circumstances requiring that the decision be delayed until the next regular meeting, you will be advised in writing of why the extension of time was needed and when the appeal will be decided.
Once the Board of Trustees has decided your appeal, you will receive a written notice of the decision. The notice will be mailed within five days of the Trustees’ decision. If the Trustees uphold the denial of your claim, you will then have the right to file suit, under the authority of the Employee Retirement Income Security Act of 1974 (ERISA), as amended. Also, if your appeal is denied, you are entitled to receive, upon request at no cost, copies of documents and information that the Plan relied on in denying your claim. See above If Your Application is Denied for more information.
If the decision on a claim or appeal is not provided within the time limits outlined in this section, the claim or appeal is considered to have been denied. No claim will be considered to have been denied until you have exhausted all of the procedures described in this section.
The final decision of the Board of Trustees on an appeal is final and binding. The Trustees’ decision will be given judicial deference in any later court action or administrative proceeding to the extent that it does not constitute an abuse of discretion and is not arbitrary or capricious. You must exhaust the Plan’s appeal procedures before bringing any court action or administrative proceeding.
The Plan contains a two-year statute of limitations. Notwithstanding any other state or federal law, any and all legal actions relating to the Plan must be filed within two years of the action or inaction on which the complaint is based. This includes but is not limited to actions to recover benefits that must be filed within two years of the final decision on a claim. As the situs of the Plan is in DuPage County, Illinois, legal actions must be brought in the United States District Court for the Northern District of Illinois.
Benefit Payment to an Incompetent Person
If benefit Plan payments are due to an incompetent or physically or mentally incapacitated person, the Trustees may make payments directly to any legal representative appointed for that individual. If the Trustees are not aware of any legal representative, the Trustees may make payment to the institution
responsible for that individual or to the spouse, child(ren), or any other person whom the Trustees reasonably determine is caring for or otherwise providing support and maintenance for the individual. If you have been appointed financial power of attorney for one of the Plan participants, please provide a copy of the power of attorney to the Fund Office.