Appeals
Plans 5, 6, 6A, 11A, 11B
If you disagree with the Fund’s reason(s) for denying your claim or request, you may appeal the decision. When you appeal a decision it means the Board of Trustees will review and reconsider the Plan’s initial determination.
To appeal a claim or request denial you must send a written statement to the Fund Administrator within 180 days of receiving a notice of adverse decision on your claim for benefits and/or request for pre-authorization. If you (or your authorized representative) do not appeal the decision within 180 days, you lose your right to appeal the decision and also your right to sue because you have not exhausted your administrative remedies. If you have a good reason for failing to appeal a decision within the period, you may file an appeal for up to one year after the denial, but you must show in your appeal that you had good cause for filing a late appeal.
Your written statement of appeal must describe in detail your claim for benefits and the reason why you believe your claim was improperly denied. In addition, the statement must include any documents you believe are pertinent to your appeal (and were not already provided to the Fund with your original claim).
Plan 7
If you disagree with the Fund’s reason(s) for denying your claim or request, you may appeal the decision. When you appeal a decision it means the Board of Trustees will review and reconsider the Plan’s initial determination.
Appeal of a Denial of a Post-Service Claim
Appeal of a Denial of an Urgent Care Claim
Appeal of a Denial of a Concurrent Care Claim