Review of Denied Claim. If a claim for benefits has been denied by the Bank, then within ninety (90) days after receipt of the ruling (or two hundred ten (210) days of the claim if the claim has not been acted upon within one hundred twenty (120) days of the claim), the Director or Beneficiary making the claim or the Director's or Beneficiary's authorized representative may file a written request for review on a form furnished by the Bank, giving the Director or Beneficiary thirty (30) days notice thereof, and notifying said claimant that said claimant may submit a written statement and documents, or appear personally at such or both, to give whatever facts or evidence the claimant feels bears upon the claim, review pertinent documents and records and submit issues and comments in writing. The Bank shall make a full and fair review of the record, including the written and oral information submitted by the claimant. Within thirty (30) days, the Bank shall render a decision and if the claim is again denied, the Bank shall set forth the specific reasons for such denial written in a manner calculated to be understood by the Director or Beneficiary. Such ruling shall contain the same information required by the Claim For Benefits paragraph, above.
Review of Denied Claim. A Participant whose application for benefits is denied, in whole or in part, may request a full and fair review of the decision denying the claim within 60 days after receipt of the notice of the denial from the Plan Administrator. The Participant may:
(a) request a hearing by the Plan Administrator upon written application to the Plan Administrator,
(b) review pertinent documents in the possession of the Plan Administrator, or
(c) submit issues and comments in writing to the Plan Administrator for review. A decision on review by the Plan Administrator shall be made promptly but not later than 60 days after the receipt by the Plan Administrator of a request for review, unless special circumstances (such as the need to hold a hearing) require an extension of time for processing, in which case the claimant will be so notified of the extension, and a decision shall be rendered as soon as possible but not later than 120 days after the receipt of the request for review. The decision shall be in writing and shall include specific reasons for the decision written in a manner calculated to be understood by the Participant and specific reference to the pertinent provisions of the Plan on which the decision is based. The Plan Administrator’s decision shall be final and binding upon all parties.
Review of Denied Claim. Upon receipt of a request for review, the Administrator shall provide written notification of its decision to the claimant stating the specific reasons and referencing specific plan provisions on which its decision is based, within a reasonable time period but not later than 60 days after receiving the request, unless special circumstances require an extension for processing the review. If such an extension is required, the Administrator shall notify the claimant in writing of such special circumstances and of the date, no later than 120 days after the original date the review was requested, on which the Administrator will notify the claimant of its decision.
Review of Denied Claim. If a Claimant wants his or her denied claim to be reconsidered, the Claimant must send a written request for a review of the claim denial to the Plan Administrator no later than 60 days after the date on which he or she receives written notification of the denial. The Claimant may include any written comments, documents, records or other information relating to the claim for benefits. The Claimant shall be provided, upon request and free of charge, reasonable access to, and copies of, all documents, records and other information relating to the claim for benefits. The Plan Administrator’s review shall take into account all comments, documents, records and other information submitted by the Claimant relating to the claim, without regard to whether such information was submitted or considered in the initial benefit determination.
Review of Denied Claim. A decision on review of a denied claim shall be made in the following manner:
(i) The decision on review shall be made by the named fiduciary or Plan Administrator, who may in its discretion hold a hearing on the denied claim. Such decision shall be made promptly, and not later than sixty (60) days after receipt of the request for review, unless special circumstances (such as the need to hold a hearing) require an extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than one hundred and twenty (120) days after receipt of the request for review.
(ii) The decision on review shall be in writing and shall include specific reasons for the decision, written in a manner calculated to be understood by the Claimant, and specific references to the pertinent Plan provisions upon which the decision is based.
Review of Denied Claim. The claimant may file a written appeal of the denial of a claim to the Chairman of the Electrical Insurance Trustees or such of his designated representatives on file in the Fund Office within 60 days from the date the claimant received notice of the denial of the claim; or, if earlier, within 60 days of the date the claim is deemed denied. In connection with the appeal, the claimant may submit, in writing, issues and comments and may also request that the claimant be permitted to review relevant documents, free of charge. The Chairman of the Electrical Pension Trustees (or Board of Trustees) or his designated representatives may entertain any oral presentation that the claimant or his duly authorized representative wishes to make or otherwise conduct a hearing. The Trustees will render a decision at the next quarterly meeting of the Board of Trustees. However, if a request for appeal is received within 30 days of a quarterly meeting, then the decision may be rendered at the subsequent quarterly meeting. If special circumstances exist, such as a required hearing, the decision may be delayed until the 3rd meeting following the date the Plan receives the request for review. If such an extension of time for review is required, the claimant shall be provided a written notice of the extension, describing the special circumstances and the date as of which the benefit determination will be made, prior to the commencement of the extension. The written decision shall be provided to the claimant within five days after the benefit determination is made. If the claim is denied on review, the written notice shall state the following: (a) the specific reason or reasons for the denial; (b) a specific reference to provisions of the Plan on which the denial is based; (c) 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 relevant to the claim for benefits as explained under 29 CFR §2560.503- 1(m)(8); and (d) a statement of the claimant’s rights to bring an action under §502 of ERISA. Such determination shall be binding on all parties.
