Pension – Appeals
Appealing a Denial of Benefits
The Plan’s claims and appeals procedures are contained in Appendix B of the Pension Plan Document. A copy of the Appendix and other documents pertaining to its claims and appeals procedures may be obtained without charge by contacting the Plan Office.
Denial of Benefits
If you or your beneficiaries apply for benefits and the Plan denies your claim for benefits, the denial notice will include:
- The specific reason(s) for the decision with references to the specific Plan provision(s) on which the claims denial is based.
- A description of any additional material or information necessary for you to perfect your claim and an explanation as to why such material or information is necessary.
- A description of the Plan’s review procedures and the time limits applicable to those procedures.
- A statement of your right to bring court action under ERISA Section 502(a) following an adverse decision upon appeal.
Filing an Appeal of Denial of Benefits
If your application for benefits is denied or if you have reason to believe you did not receive the full amount of benefits to which you are entitled, you may file an appeal with the Board of Trustees to request a review of the denial.
The petition must be in writing and should clearly state the reasons why your pension application should be reviewed. In support of your appeal, you may submit written comments, documents, records or other information related to the appeal.
Upon written request, you may request – at no charge – reasonable access to and copies of any documents, records and other information if they (1) were relied upon in making the initial determination; (2) were submitted, considered or generated in the course of making the benefit determination – even if not relied upon, (3) demonstrate that the Plan provisions have been followed and applied consistently with respect to similarly situated individuals, or (4) constitute a statement of policy or guidance with respect to the Plan concerning the denied benefits – whether or not relied upon.
It must be received in the Plan Office (at the address shown below) within 60 days after receipt of the notice advising you about your pension. If the petition is not filed within the required 60-day period, the right to a review of the denial is waived.
NORTHERN CALIFORNIA GLAZIERS, ARCHITECTURAL METAL
AND GLASSWORKERS PENSION PLAN
c/o Health Services & Benefit Administrators, Inc.
4160 Dublin Boulevard, Suite 400
Dublin, CA 94568-7756
Review of the Appeal
Appeals are reviewed at the next regularly scheduled meeting of the Board of Trustees. However, if your written appeal is received within 30 days of the scheduled Board of Trustees meeting, it will instead be heard at the next scheduled Board of Trustees meeting. If special circumstances result in additional time needed to consider your case, the appeal may be decided upon at the third scheduled meeting. You will be notified of any extension of time for review.
The Board of Trustees review of your appeal will take into account all comments, documents, records, and other information subjected by you without regard to whether such information was submitted or considered when your claim was originally denied.
A decision will be made and communicated to you in writing by the Board of Trustees within 5 days after the appeal is decided.
If your appeal is denied, the notice of denial will contain the following information:
- The specific reason(s) for the decision with references to the specific Plan provision(s) on which the appeals denial is based.
- A statement that you are entitled to receive upon request and without charge, reasonable access to and copies of all documents, records and other information relevant to your claim.
- A statement of your right to bring court action under ERISA Section 502(a).
Following the issuance of the appeals denial, you have no right to appeal or arbitrate the Board’s decision.
This procedure must be followed by anyone who believes he/she should not have been denied a benefit; or who believes his/her pension benefit should be increased. The appeal process must be exhausted before any other action may be taken with respect to a claim.