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Health Fund

Life Insurance and Accidental Death and Dismemberment Claims

If the claim is for benefits other than health care or disability benefits (such as life insurance and accidental death and dismemberment), the claims and appeals rules described in this section apply, except as follows: the Claims Administrator will notify the claimant of its decision within a reasonable time but not later than 90 days after receipt of the claim, unless the Claims Administrator determines that special circumstances require an extension of up to an additional 90 days. If the claim is denied, the claimant will have 60 days from receipt of notification to appeal the determination.

If an audit discovers that the employer has mistakenly reported earnings to the Plan and Fund, or if it is discovered that earnings were reported in an incorrect time period that results in the rescission of coverage but, the participant may ask the Audit & Delinquency Committee to review the Administrators decision, if they feel the decision was reached erroneously.