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OPERATING ENGINEERS
TRUST FUNDS

Appealing the Denial of a Claim

If your application for benefits or other written claim under the Plan has been denied, in whole or in part, you will be notified in writing of the denial. This written notice will explain the reasons for the denial and outline what you can do to request reconsideration by the Trustees and to justify the claim. This notice will be provided to you within 90 days (45 days for a disability claim) of the receipt of your claim by the Plan. There may be special circumstances which will make additional time necessary in which case the Trustees may take up to an additional 90 days (30 days for a disability claim). The Trustees will notify you of the delay and the reasons for it.

If your claim is denied, you can request that the Trustees reconsider the decision denying your claim. The request must be in writing and state in a clear and concise way the reason for your disagreement with the Trustees’ decision, and it must include any substantiating evidence you may have. This written request must be filed with the Fund Office within 60 days of the date of your receipt of the denial of your claim. If you do not meet this 60-day filing requirement, your claim can be denied again. You will then be prevented from asking the Trustees to reconsider their decision on the basis of evidence the Trustees had before making the original decision.

The Trustees, or a committee appointed by them, will consider your written claim if it is filed on time, and make a decision at the next regularly scheduled meeting of the Trustees. However, if your claim is received by the Fund Office less than 30 days before the next regularly scheduled Trustees meeting, your case will be reviewed at the second regularly scheduled meeting after the Trustees receive your appeal. If the Trustees need more time to review your appeal because of special circumstances, you will be notified of the delay, and the Trustees will make the decision as soon as possible but not later than the third regularly scheduled meeting after receiving your appeal. You will be notified of the appeal decision in writing promptly after the meeting in which your appeal was heard.

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