Summary Plan Description (Revised January 1, 2012)

Claims and Appeals Procedures

Denial of Application or Claim

If your application for benefits (other than disability retirement benefits) or your claim to a benefit is denied, in whole or in part, you will be notified in writing of the denial within 90 days after receipt of your application or claim. This 90-day period may be extended for up to 90 days if required by special circumstances. If an extension is required, you will be notified in writing of such circumstances and the date by which a final decision is expected to be rendered before the end of the initial 90-day period.

If your application for disability retirement benefits is denied, in whole or in part, you will be notified in writing of the denial within 45 days after receipt of your application. This 45- day period may be extended for up to 30 days (to a total of 75 days) if the plan determines that an extension of time for making the determination is necessary due to matters beyond the control of the plan, and notifies you prior to the expiration of the initial 45-day period of the circumstances requiring the extension of time and the date by which the plan expects to render a decision. If the plan determines that an additional extension of time for making the benefit determination is necessary due to matters beyond the control of the plan, and notifies you prior to the expiration of the first 30-day extension period of the circumstances requiring the extension of time and the date by which the plan expects to render a decision, then the period for making a benefit determination may be extended by the plan for an additional 30 days (to a total of 105 days). If an extension is necessary due to your failure to submit information necessary to process the application, the notification of the extension will describe the necessary information, and you will be provided at least 45 days from receipt of the notification to submit the additional information. The period for making a determination will be tolled from the date on which the notification of the extension is sent to you until the date on which you respond to the request for additional information. If an extension is necessary, the notification of the extension will specifically provide:

  • An explanation of the standards on which entitlement to a benefit is based.
  • The unresolved issues that prevent a decision on the application.
  • The additional information needed to resolve the issues.

If your application or claim is denied, you will be notified in writing of the following:

  • The specific reasons for the denial.
  • Specific reference to pertinent plan provisions on which the denial is based.
  • A description of any additional material or information necessary for you to perfect your application or claim and an explanation of why such material or information is necessary.
  • An explanation of the plan's application and claim review procedure, including a statement of your right to bring a civil action under ERISA § 502(a).
  • With a denial for disability retirement benefits, if an internal rule, guideline, protocol, or other similar criterion was relied upon in making the adverse determination, either the specific rule, guideline, protocol, or other similar criterion, or a statement that such a rule, guideline, protocol, or other similar criterion was relied upon in making the determination and that a copy of the same will be provided free of charge to you upon request.
Request For Appeal

If your application or claim is denied, you have the right to appeal to the Board of Trustees for a review of the denial. This review is known as an appeal. The notice of appeal must be in writing and should contain the information described in Notice of Appeal to Trustees as well as the following information:

  • A statement as to each ground on which you believe the decision or other action appealed from to have been in error.
  • A list of the names and addresses of each person on whose testimony you will rely, in whole or in part, in support of the appeal, together with a short statement of the facts to which each person is expected to testify.
  • A list of each document on which you will rely in support of your appeal.

You must make this request in writing to the Board of Trustees at the Trust Office within 60 days after you are notified of the denial of your application or claim. With disability retirement benefit appeals, you must make this request in writing within 180 days after you are notified of the denial of your application or claim. The failure to file a written appeal within the time period described above will bar your right to appeal and the application or claim decision will be final.

Scheduling An Appeal

Upon receipt of a timely-filed appeal, the Trustees will set a date for your hearing, if requested.

The appeal will be conducted by the Board of Trustees or by the Appeals Committee of the Board of Trustees, which has been given the authority for making a final decision in connection with the appeal.

The Trustees will review a properly filed appeal at the next regularly scheduled quarterly meeting of the Appeals Committee, unless the request for review is received by the Trustees within 30 days preceding the date of such meeting. In such case, the appeal will be reviewed no later than the date of the second quarterly meeting following the Trustees' receipt of the notice of appeal, unless there are special circumstances requiring a further extension of time, in which case a benefit determination will be rendered not later than the third quarterly meeting of the Appeals Committee following the Trustees' receipt of the notice of appeal. If such an extension of time for review is required because of special circumstances, such as a request for a hearing on the appeal, then prior to the commencement of the extension, the plan will notify you in writing of the extension, describe the special circumstances and the date as of which the benefit determination will be made.

Appeal Procedures

You are entitled to present your position and any evidence in support thereof, and may appear in person at the appeal hearing. You may be represented by an attorney or by any other representative of your choosing at your own expense. You may submit written comments, documents, records, and other information relating to your appeal. You will be provided upon request and free of charge, reasonable access to, and copies of, all documents, records and other information relevant to your appeal.

You must introduce sufficient credible evidence on appeal to establish, prima facie, entitlement to the relief from the decision or other action from which the appeal is taken. You will have the burden of proving your right to relief from the decision or action appealed, by a preponderance of evidence. The Trustees will review all comments, documents, records and other information submitted by you related to the appeal, regardless of whether such information was submitted or considered in the initial benefit determination. The Trustees will not afford deference to the initial adverse benefit determination.

When deciding an appeal of a denial for disability retirement benefits that is based in whole or in part on a medical judgment, the Trustees will consult with a health care professional who has appropriate training and experience in the field of medicine involved in the medical judgment. Any medical or vocational expert whose advice was obtained on behalf of the plan in connection with the adverse benefit determination will be identified to you upon request. Any health care professional engaged for the purpose of a consultation will not be an individual who was consulted in connection with the initial adverse benefit determination that is the subject of the appeal, nor the subordinate of any such individual.

Decision of Trustees

The Trustees will issue a written decision on review as soon as possible, but not later than five days after the determination is made. The decision will include:

  • The specific reasons for the decision.
  • Specific references to pertinent plan provisions on which the denial 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 your appeal.
  • In the case of a denial of disability retirement benefits, a statement of your right to bring a civil action under ERISA § 502(a).
  • In the case of a denial of disability retirement benefits, if an internal rule, guideline, protocol, or other similar criterion was relied upon in making the adverse determination, either the specific rule, guideline, protocol, or other similar criterion, or a statement that such a rule, guideline, protocol, or other similar criterion was relied upon in making the determination and that a copy of the same will be provided free of charge to you upon request.

In deciding appeals, the Trustees have the discretionary authority and the exclusive right to construe and interpret the provisions of the plan, and to determine any and all questions arising thereunder or in connection with the administation thereof including the right to remedy possible ambiguities and inconsistencies or omissions. Any such construction or determination by the Trustees made in good faith shall be conclusive on all persons affected thereby.

Following issuance of a written decision of the Trustees on an appeal for disability retirement benefits, there is no further right of appeal to the Trustees or right to arbitration. Instead, you may bring a civil action under ERISA § 502(a).

Arbitration

If you are dissatisfied with the written decision of the Trustees (other than a decision on a denial of disability retirement benefits), you may request a further appeal by arbitration in accordance with the Employee Benefit Plan Claims Arbitration Rules of the American Arbitration Association. Your request must be made in writing within 60 days of receipt of the Trustees' written decision. Failure to initiate arbitration timely will bar any further consideration of the appeal. If requested, the administrator will assist you in preparing the request for arbitration. If the matter is submitted to arbitration, the appeal will be limited to a transcript of witness testimony, the exhibits and the Findings and Decision of the Trustees (or Appeals Committee of the Trustees). The arbitrator will not have the power or authority to add to, subtract from, or in any way modify the plan, the Trust Agreement, insurance contracts, if any, or the rules and regulations of the Trust. The question for consideration by the arbitrator will be whether, in the particular instance:

  • The Trustees were in error upon an issue of law.
  • The Trustees acted arbitrarily or capriciously in the exercise of their discretion.
  • The Trustee's findings were supported by substantial evidence.

The expense of arbitration will be borne equally by you and the Trust unless otherwise ordered by the arbitrator. Each party is responsible for its own attorney fees. The decision of the arbitrator is final and binding on all parties, and judgment upon the award may be entered in any Court having jurisdiction thereof. You must exhaust your remedies under the forgoing procedures as a condition precedent to the commencement of any suit.

  • For additional information about the appeals procedure, please see Article 10.3.