Appealing Adverse Benefit Determinations
After receiving notice of an adverse benefit determination, a claimant (or authorized representative) may submit a written request to the Board of Trustees for their review and final decision. Any request for review must be filed within 180 days of the claim denial. A request for review must be directed to:
Board of Trustees
c/o Benefit Plans Administrator
Pension Plan of Carpenters’ Pension Trust Fund of St. Louis
1419 Hampton Avenue
St. Louis, Missouri 63139
A request for review should state the reason why the claimant believes the claim denial was improper, and should include any comments, documents, records, or other information the claimant wishes to be considered in support of the appeal. The Trustees will consider all such submissions as part of the review. As required by law, the Board of Trustees claim review will not give deference to the original claim decision.
In the review of a claim for disability pension, if the original claim denial was the result of a medical judgment, the Plan will consult with a health care professional who has the appropriate training and experience to render an informed opinion. The health care professional will not be the one used for the original claim determination, nor a subordinate of the original professional. The identity of the health care professional consulted by the Plan will be disclosed upon written request.
The Board of Trustees, as fiduciaries of the Plan, will generally make a decision on the review within 45 days after receipt of the request for review, unless special circumstances require an extension of time for processing, in which case a decision will be made as soon as possible, but not later than 90 days after receipt of the request for review. If such an extension is required, you will be notified in writing before the end of the original 45-day period of the reasons and the date by which the Plan expects to render a decision.
The Trustees may appoint an Appeals Committee to consider and decide appeals. Decisions made by the Appeals Committee shall have the same force and finality as decisions made by the full Board of Trustees.
Notice of the Trustees’ decision to deny the appeal in whole or in part on the review will be given to the claimant in writing and will include the specific reasons for the decision, as well as specific references to the pertinent Plan provisions on which the decision is based, and other information of the types contained in the original notice of adverse benefit determination issued by the Plan. The decision of the Trustees on appeal is final. Any civil action under Section 502(a) of ERISA must be filed within two years of the date of the Trustees’ decision. [Appendix C]