Summary Plan Description
Life Insurance and Accidental Death and Dismemberment Claims Appeal Procedure
If a request for life insurance benefits is denied in whole or in part, you will be given written notification of such denial. This notice will include:
- The reason(s) for the denial.
- Specific reference to the plan provision on which the denial is based.
- A description of any additional material necessary for you to perfect the claim.
- An explanation of the claim review procedure included in this section.
If you are dissatisfied or do not agree with the reasons for the denial of the claim, you may appeal the decision to the life insurance carrier. The address is available from Carpenters Trusts.
Your appeal must be made within 60 days of the date you receive the letter denying the claim.
The appeal must be in writing and can be made by you or your duly authorized representative. It must set out your reasons for your dissatisfaction or disagreement. Any evidence or documentation to support your position should be submitted with your written appeal. Upon written request, you may review pertinent documents that pertain to the claim and its denial.
The life insurance company will promptly review the claim and appeal. It will advise you of its decision with specific references to pertinent policy provisions on which the decision is based. This written decision will be sent to you no later than 60 days after receipt of your written appeal, unless special circumstances require an extension of time for processing the appeal, obtaining more information, or conducting an investigation of the facts. In no event will the written decision be sent later than 120 days after the life insurance company receives your written appeal.
As an alternative to appealing a denial to the life insurance company, or if you are dissatisfied with their decision, you may appeal your case to the Trustees pursuant to the procedures outlined under Appeal to Board of Trustees. Send your request to Carpenters Trusts.
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