Bakery Drivers Local 734 - Health and Welfare Fund | Appeal and Review
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Appeal and Review

Appeal and Review Procedure

If your application for benefits has been denied in whole or in part, you will be notified in writing, within five days after a decision is made. The written notice will include an explanation:

  • Stating the reason it was denied;
  • Referring you to the parts of the Plan document used to make the decision;
  • Requesting more information or materials necessary to reconsider your application and explaining why the information is needed;
  • Identifying the steps you can take to ask for a review of the decision; and
  • Informing you of your rights, under ERISA, to bring a civil suit following review of your claim.

You, your authorized representative or beneficiary may file an appeal with the Fund Office no later than 60 days (180 days for a distribution due to disability) after you receive notice that your application for benefits has been denied. You may authorize an individual to act on your behalf for filing a benefit appeal. The Board of Trustees may, in its discretion, establish procedures for determining whether an individual has been authorized to act on your behalf. Your appeal must be in writing, state the reason for your dispute, and include any pertinent documentation. The appeal must be submitted to:

Board of Trustees
Local 734 Pension Fund
6643 North Northwest Highway
Chicago, Illinois 60631

You or your authorized representative may request to appear before the Board of Trustees, or the Trustees may require your personal attendance at a hearing regarding your review. You will be notified if your request is granted, or if your attendance is required.

The Trustees will make a decision within 60 days (45 days for a distribution due to disability) after your appeal is received unless special circumstances (for example, you request a hearing) require an extension of time for processing. If an extension is needed, you will be notified in writing. You will receive a decision in writing no later than 120 days (90 days for a distribution due to disability) after your appeal was received. Any request to you for more information, must be made within the initial 45-day period. You then have 45 days to provide the information. If you do not provide the requested information, then the claim will be denied within 30 days of your deadline.

The Trustees may make a decision at the next quarterly meeting or they may delay the decision until the next quarterly meeting if the appeal is not received at least 30 days in advance of the next scheduled meeting. You must be notified within five days of the Board’s decision.

The final written decision will include references to parts of the Plan used to make the decision.

If your claim is denied on the basis of a medical judgment, the Plan will consult with a health care professional who:

  • Has appropriate training and experience in the field of medicine involved in the medical judgment; and
  • Was not consulted (or is not subordinate to the person who was consulted) in connection with the denial of your claim.

You have the right to be advised of the identity of any medical experts consulted in making a determination of your appeal. When the Plan notifies you of its determination on your appeal, it will provide:

  • The specific reason or reasons for the decision, including reference to the Plan provisions on which the decision was based; and
  • A statement notifying you that you have the right to request a free copy of all documents, records and relevant information;
  • Information relating to any additional voluntary appeal procedures offered by the Plan; and
  • A statement that you may bring a civil action suit under ERISA.

In addition, for a distribution due to disability, the notice will include:

  • A copy of any internal rule, guideline, protocol or similar criteria that was relied on or a statement that a copy is available to you at no cost upon request; and
  • A copy of the scientific or clinical judgment, or statement that is available to you at no cost upon request if your claim is denied due to medical necessity, experimental treatment or similar exclusion or limit.

If your appeal is denied, you can decide whether you want to seek legal help. See your rights under ERISA.

The Trustees may delegate to a subcommittee authority to review any petition, grant a hearing on a petition, accept an extension, or conduct a hearing. Any action by an appointed subcommittee of the Board of Trustees will be considered to be an action by the Board of Trustees.