A decision regarding the status of your application or Claim for Benefits shall be made by the Fund Office within 90 days from the date the Claim is received by the Fund Office. If, however, the Fund Office determines that special circumstances require an extension of time for processing your Claim, this period may be extended. However, in no event will the extension of time exceed an additional 90 days after expiration of the initial period. If an extension is required, written notice of the extension, along with an estimate of the date on which the Fund Office expects to make its final decision, will be furnished to you, the “claimant”, before the end of the initial 90-day period. If the extension is required due to your failure to submit information necessary to decide the Claim, the period for making the determination will be extended by the length of time between the date on which the extension notice is sent to you and the date on which you respond to the Fund Office’s request for information.
Please remember that a request for a pension estimate is not an application or a Claim for Benefits subject to the above time limits.
If your application for benefits under the Plan has been denied, in whole or in part, you will be provided with adequate notice of the determination in writing setting forth:
- the specific reason(s) for such denial of benefits, with references to the specific Plan provisions on which the determination is based;
- a description of any additional material or information necessary for you to perfect the Claim (including an explanation as to why such material or information is necessary); and
- a description of the Plan’s Claims Review procedures and the time limits that apply, including a statement of your right, following a denial of your Claim on review, to bring a lawsuit under Section 502(a) of the Employee Retirement Income Security Act of 1974, as amended (“ERISA”).
Right to Appeal an Application Denial
If your Claim For Benefits has been denied, in whole or in part, by the Fund Office, you (or your authorized representative) may appeal the denial of benefits by written request filed with the Plan’s Board of Trustees (or a committee designated by the Board of Trustees) within 180 days after receipt of the notice of denial.
In connection with a request for review, you (or your authorized representative) may submit written comments, documents, records, and other information relating to the Claim to the Trustees. You will also be provided, upon written request and free of charge, with reasonable access to (and/or copies of) all documents, records and other information relevant to the Claim. The review by the Trustees will take into account all comments, documents, records, and other information submitted by you relating to the Claim, regardless of whether such information was submitted or considered in the initial benefit determination.
A decision on review will be made by the Board of Trustees (or a committee designated by the Board of Trustees, which may not include any person that participated in the decision to deny the Claim for benefits) within 60 days. Special circumstances may require an extension of time of up to an additional 60 days for processing the request for review. In this case, you will receive a notice describing the special circumstances requiring the extension, and including the date as of which the determination will be made. If any extension under this paragraph is required due to failure to submit information necessary to decide the Claim, the period for making the determination will be extended by the length of time between the date on which the extension notice is sent to you and the date on which you respond to the Trustees’ request for information. You shall be given a reasonable period of time to provide the requested information.
The decision on review will be in writing and sent to you. The decision will include:
- the specific reason(s) for the decision, written in an understandable manner;
- specific references to the plan provisions on which it 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 the Claim; and
- a statement describing your rights to obtain additional information regarding the Plan’s appeals process, including a statement of your right to bring a civil action under Section 502(a) of ERISA.
The Board of Trustees, as the “named fiduciary” of the Plan under ERISA, has the sole authority to apply and interpret the terms of the Plan. The decision of the Board of Trustees concerning an appeal is final and binding. If a participant in the Plan disagrees with the Trustees’ decision on an appeal and files a lawsuit, the judge hearing the case must respect that decision and find in the Trustees’ favor, unless it determines that the Trustees’ decision was clearly unreasonable.