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Health Fund

Appealing A Denied Claim

If a claim is denied, the claimant will have 180 days from receipt of the denial to submit a written appeal. The appeals decision for any claims denied by the Administrative Office will be conducted by the Fund's Benefits Committee. (However, the Benefits Committee may delegate this power with respect to certain pre-service claim appeals or first level claim appeal review.)

The claimant may submit written comments and other information relating to the claim for consideration on appeal. The claimant will be provided, upon request and free of charge, other information relevant to the claimant's claim, including the identity of any medical consultant who reviewed the initial claim. The appeals decision will not afford deference to the initial adverse determination and will be conducted by an individual or individuals who are neither the individual who made the initial determination nor his/her subordinate.