Life Insurance Claims Appeal Procedure

If a request for life insurance benefits is denied in whole or in part, the participant 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 the participant to perfect the claim.
• An explanation of the claim review procedure included in this section.

If the participant is dissatisfied or does not agree with the reasons for the denial of the claim, he or she may appeal the decision to the life insurance carrier. The address is available from the Trust Office.

The participant’s appeal must be made within 60 days of the date he or she receives the letter denying the claim.

The appeal must be in writing and can be made by the participant or his or her duly authorized representative. It must set out the reasons for the dissatisfaction or disagreement. Any evidence or documentation to support this position should be submitted with the written appeal. Upon written request, the participant 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 the participant of its decision with specific references to pertinent policy provisions on which the decision is based. This written decision will be sent to the participant no later than 60 days after receipt of the 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 the written appeal.

As an alternative to appealing a denial to the life insurance company, or if the participant is dissatisfied with their decision, the participant may appeal the case to the Trustees pursuant to the procedures outlined under Claims Appeal Procedure. Send the request to the Trust Office.