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Service Employees 32BJ North Pension Fund
North Pension Fund Summary Plan Description (SPD)
>> Filing a Claim for Benefits
In order to receive benefits from the Fund, you must complete an
application form and submit it with all requested documents to 101
Avenue of the Americas, New York, NY 10013. Your application will not
be considered complete until all requested documents are received by the
Fund. The application form will explain what documents are required as
well as the benefit options available to you. The Fund Office is available
to help answer any questions you may have about completing the form.
Denial of a Claim
If your claim for benefits is denied, in whole or in part, you will
receive a written explanation of the reason(s) for the denial usually
within 90 days after your claim has been received by the Fund Office.
If additional time of up to 90 days is required because of special
circumstances, you will be notified in writing of the reason for the delay,
and the date that the Fund expects to issue a final decision. A decision
will be made with respect to your claim no more than 180 days from the
date your claim is first filed with the Fund Office.
If your claim is denied, you will receive a written explanation that
contains the following information:
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the specific reason(s) for the denial;
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reference to the specific provision of the Plan document or rule on
which your denial is based;
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a description of additional materials you would need to perfect your
claim and an explanation of why we need this material;
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the steps you must take if you want to have your denied claim
reviewed, including the amount of time you have to do this; and
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your right to bring an action under ERISA if you decide to appeal and
that appeal is denied.
You must include in your written appeal all the facts regarding your
claim as well as the reason(s) you feel the denial was incorrect. You
may receive, upon request and free of charge, reasonable access to and
copies of documents relevant to your claim. You may submit issues and
comments in writing, and documents relating to your claim.
Claim for Disability Benefits
If your claim for a disability benefit is denied, in whole or in part,
you will receive a written explanation of the reason(s) it was denied
usually within 45 days after your claim has been received by the
Fund. The Fund may require an additional 30 days, and occasionally
another 30 days beyond that, for reasons beyond the control of the Fund,
including your failure to properly file your claim or submit sufficient
information for the Fund to process it. If extra time is required, you will
be notified in writing explaining the reason for the delay, the standards
for entitlement to a benefit, any unresolved issues and additional
information required, and the date that the Fund expects to issue a final
decision. If the Fund requests additional information, you will have 45
days to respond. The Fund will not decide your claim until you respond
or the 45 days expires, whichever comes first. If you do not submit the
requested information, the Fund will decide the claim based on the
information it has.
Appeals Procedures
If your application is denied, in whole or in part, and you want to
dispute the denial, you must file a written request for a review of your
application by the Trustees within 60 days after receiving written
notification of the denial. Except for a denial of a claim for disability
benefits, you have 180 days to submit a written request for review. Such
written request must include all the facts regarding the application, as
well as the reasons you believe the denial was incorrect. Your appeal will
be deemed filed upon receipt of it by the Trustees. You may receive, upon
request and free of charge, reasonable access to and copies of documents
relevant to your application. You may also submit additional documents
to support your application.
You may name a representative to act on your behalf. To do so, you
must notify the Trustees in writing of the representative’s name, address
and telephone number. You may also, at your own expense, have legal
representation at any stage of this review process. However, the Trustees
are not responsible for paying any legal expenses you incur during the
course of an appeal.
The Trustees, in making their decision on your appeal, will apply
the terms of the Plan document and any applicable guidelines, rules
and schedules, and will periodically verify that benefit determinations
are made in accordance with such documents. The Trustees will also
consider all information you submit.
The Trustees will decide your appeal at the Board of Trustees
meeting that immediately follows receipt of the appeal; provided,
however, if you make a request for review of a denied claim and such
request for review is received within 30 days of a Trustees’ meeting, the
Trustees’ decision will be made at the second meeting held after receipt
of the appeal. If special circumstances require a further extension of
time, the decision will be made no later than the third Board of Trustees
meeting following the Fund’s receipt of your appeal.
If your appeal is denied, the denial notice will set forth the specific
reason for the denial and the specific Plan provisions on which the denial
is based. The denial notice will include a statement of your right to bring
a lawsuit under ERISA, and a statement that you are entitled, upon
request and free of charge, to copies of all documents relevant to your
claim.
If you fail to file a notice of appeal within the time provided, the
original decision on your claim becomes final and binding. You must
exhaust these administrative remedies before you can bring a lawsuit in
federal court under ERISA.
The Board of Trustees has the power to interpret, apply, construe,
and amend the provisions of the Plan and make factual determinations
regarding its construction, interpretation and application, and any
decision made by the Board of Trustees in good faith is binding upon
employers, Employees, Participants, Beneficiaries, and all other persons
who may be involved or affected by the Plan.
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