Appeal Procedure for Denied Claim or Adverse Benefit Determination Sample Clauses

Appeal Procedure for Denied Claim or Adverse Benefit Determination. If you wish to appeal an adverse benefit determination or a denial of a claim for welfare benefits, you or your authorized representative must file a written appeal with the Board of Trustees (also known as the Plan Administrator) within 180 days after receipt of written notice of denial or otherwise known as adverse benefit decision. You or your authorized representative may submit a written statement, documents, records, and other information relating to the claim for benefits. You may also, free of charge upon request, have reasonable access to and copies of Relevant Documents relating to the claim for benefits. Relevant Document means any document, record or other information that: ➢ Was relied upon in making a benefit determination including a decision to deny benefits; ➢ Was submitted, considered, or generated in the course of making the decision to deny benefits, whether or not it was relied upon in making the decision to deny benefits; ➢ Demonstrates compliance with any administrative processes and safeguards designed to confirm that the benefit determination was in accord with the Fund and that the Fund provisions, where appropriate, have been applied consistently regarding similarly situated individuals; or ➢ Constitutes a statement of policy or guidance to the Plan concerning a denied treatment option or benefit for you diagnosis, whether or not it was relied upon in making the decision to deny benefits.