Claims Appeal Procedure

If a claim is denied by the plan administrator or the administrator’s representative, the participant has the right to request the Board of Trustees to review the decision of the administrator. This review is known as an appeal. However, the participant must make this request, in writing, to the Trustees at the Trust Office within 60 days after notification of the denial of the claim.

The participant’s request must set out the reasons for the appeal and the participant’s dissatisfaction or disagreement. Any evidence or documentation to support this position should be submitted with the written appeal.

The participant has the right to review the pertinent documents in his or her file. The participant is entitled to submit evidence to the Trustees on behalf of his or her appeal. In most instances, the participant will have the right to a hearing before an Appeals Committee of the Board of Trustees. The participant has the right to be represented by counsel. The details of the procedures for hearings before the Trustees are set forth in a separate document, which will be sent to the participant if a hearing is requested.

After consideration of the appeal, the Appeals Committee of the Board of Trustees will issue a written statement granting or denying the appeal. If the appeal is denied, the Trustees will provide specific reasons for the denial of the appeal.

If the participant is dissatisfied with the determination by the Trustees, he or she may ask for arbitration, in accordance with the Employee Benefit Plan Claims Arbitration Rules of the American Arbitration Association. This request must be made, in writing, within 60 days after the participant is notified of the formal decision of the Appeals Committee of the Board of Trustees. If requested, the plan administrator will help the participant prepare the request for arbitration.

The arbitrator’s review is an appellate-type review, which will be limited to the evidence in the record. The scope of the arbitrator’s review is limited to these issues:

• Whether the decision of the Trustees is supported by substantial evidence.
• Is erroneous as a matter of law.
• Is arbitrary and capricious.

The expense of arbitration will be borne equally by each party. However, each party shall bear their own attorney fees.