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Defined Contribution Plan Document


Section 13: Claims Review and Appeals Procedure.

  1. No Participant, Annuitant, Beneficiary or other person shall have any right or claim to benefits under this Plan, other than as specified in this Plan. If any person shall have a dispute with the Trustees as to eligibility, type, amount, or duration of such benefits, the dispute shall be resolved solely by the Trustees under and pursuant to this Plan, and its decision of the dispute shall be final and binding upon all parties thereto, subject to applicable federal law.

  2. Any person whose application for benefits under the Plan has been denied in whole or in part, or whose claim to benefits or against the Fund is otherwise denied, shall be notified in writing of such denial within 90 days after receipt of such application or claim. An extension of time not exceeding 90 days may be required by special circumstances; if so, notice of such extension, indicating what special circumstances exist therefor and the date by which a final decision is expected to be rendered, shall be furnished the claimant prior to the expiration of the initial 90 day period. The notice of denial shall set forth in a manner calculated to be understood by the claimant,
    1. The specific reason or reasons for the denial;
    2. Specific reference to pertinent Plan provisions on which the denial is based;
    3. A description of any additional material or information necessary for the claimant to perfect the claim and an explanation of why such material or information is necessary;
    4. Appropriate information as to the steps to be taken if the claimant wishes to submit his or her claim for review; and
    5. A description of the Plan's review procedures and time limits applicable to such procedures, including a statement of the participant's right to bring a civil action under ERISA Section 502(a) following exhaustion of the Plan's appeal procedures.

  3. Any such person may petition the Trustees for a review of the denial. A petition for review shall be in writing, shall state in clear and concise terms the reason or reasons for disputing the denial, shall be accompanied by any pertinent documentary material not already furnished to the Trustees, and shall be filed by the petitioner or his duly authorized representative with the Trustees within 60 days after the petitioner received notice of the denial. The petitioner or his duly authorized representative shall be permitted to review pertinent documents and submit issues and comments in writing.

  4. Upon good cause shown, the Trustees shall permit the petition to be amended or supplemented and shall grant a hearing on the petition before a hearing panel to receive and hear any evidence or argument which cannot be presented satisfactorily by correspondence. The failure to file a petition for review within such 60 day period or the failure to appear and participate in any such hearing, shall constitute a waiver of the claimant's right to review of the denial, provided that the Trustees may relieve a claimant of any such waiver for good cause if application for such relief is made within one year after the date shown on the notice of denial.

  5. A decision by the Trustees shall be made promptly and not less than 60 days after the Trustees' receipt of the petition for review, unless special circumstances require an extension of such time for processing, in which case notice of such extension shall be furnished to the claimant prior to the expiration of the 60 day period. A decision shall be rendered as soon as possible, but no later than 120 days after receipt of the petition for review. The petitioner shall be advised of the Trustees' decision in writing. The decision shall include specific reasons for the decision, written in a manner calculated to be understood by the petitioner and specific references to the pertinent Plan provisions on which the decision is based. The decision shall also include a statement that the claimant is entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records and other information relative to the claimant's claim for benefits and a statement of the claimant's right to bring a civil action under ERISA Section 502(a).

  6. The decision of the Trustees with respect to a claim or petition for reconsideration shall be final and binding upon all parties, including the petitioner and any person claiming under the petitioner. The provisions of this section shall apply to and include any and every claim to benefits from the Fund, and any claim or right asserted under this Plan or against the Fund, regardless of when the act or omission upon which the claim is based occurred.

  7. Entitlement to a Disability Benefit under the Plan, which is not based on a Social Security Award but is based on competent medical evidence, is a "disability benefit" under Department of Labor Regulation Section 2560.503-1, and thus is subject to special claims and appeals procedures. The Board of Trustees adopts the following changes to the claims and appeals procedures for such disability benefits only:
    1. The Board of Trustees will notify the claimant of the Board's adverse benefit determination within a reasonable period of time, but not later than 45 days after receipt of the claim by the Board. This period may be extended for up to 30 days, provided the Board determines such extension is necessary due to matters beyond the control of the Board and notifies the claimant (prior to the expiration of the initial 45-day period) of the circumstances requiring the extension and the date the Board expects to render a decision. An additional 30-day extension is allowed, provided the Board again determines it is necessary and notifies the claimant (prior to the end of the first 30-day extension period). Any notice of extension will specifically explain the standards on which entitlement to a benefit is based, the unresolved issues that prevent a decision on the claim, and additional information needed to resolve those issues. The claimant will be afforded at least 45 days to provide such information.
    2. A claimant for disability benefits will be allowed 180 days following receipt of notice of an adverse benefit determination to appeal the decision.
    3. Review of a claim for disability benefits will not afford deference to the initial benefit determination. Review of a claim for disability benefits upon appeal will continue to be made at regular meetings of the Board of Trustees.