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 Appeal 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.
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:
If you receive a notice that your claim for Pension Benefits has been denied, or if you disagree with a policy, determination or action of the Fund, you may submit a written appeal to the Trustees requesting that the Board of Trustees review your benefit denial or the Plan policy, determination or action with which you disagree.
The time you have to appeal to the Trustees will depend on the type of claim denied:
You will be entitled to a full and fair review. Your written appeal should state the reason for your appeal. This does not mean that you are required to cite all applicable provisions or make “legal” arguments; however, you should state clearly why you believe you are entitled to the benefit you claim, or why you disagree with a Plan policy, determination or action.
You are permitted to submit written comments, documents, records and other information relating to your claim even if such information was not 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 no later than the second quarterly Trustees’ meeting after the appeal is received. If special circumstances arise which warrant an extension of time to make a decision on appeal, such as the need for additional information, then the Trustees may provide written notice of the Extension to the participant or beneficiaries, and may then wait until the following quarterly Trustees’ meeting after of the notice of appeal. 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.
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.
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: