Summary Plan Description Table of Contents
Applying for Benefits
When you retire or leave covered employment, you should request an application from the Fund Office. You should apply for benefits 60 – 180 days before you want payments to begin. Payments cannot be made to you until an application is received at the Fund Office and approved by the Trustees. The Trustees will rely on any information you provide when reviewing your application. If your application is for a distribution due to a Disability, see page 16.
Generally, within 60 days of receipt of your application, you will be notified of whether or not you are eligible for benefits. If you are eligible, you will receive an explanation of the forms of payment available to you (or your beneficiary). You will then need to decide what form of payment you wish to elect. If additional information is needed to make a decision on your application, you will be notified in writing and will have 45 days to provide the information. The initial 45-day review period the Plan has to make a decision will be suspended until the earlier of the date you provide the requested information or 45 days after the date you were asked to provide the information.
Under special circumstances, the initial application determination period may be extended by up to 60 days. If additional time is required to make a determination on your claim, you will be notified within the initial 60-day period of the reason for the extension and when you can expect a decision.
Generally, once your application has been approved, benefits will be paid beginning the first day of the month following the month your application is approved. If your application is denied, you have the right to request a review (appeal).
In the event the Trustees determine that you, your surviving spouse or beneficiary is unable to care for your affairs because of mental or physical incapacity, any payment due may be applied to your maintenance and support or to a person the Trustees find to be appropriate.
If Your Application Is Denied
If your application for benefits is denied, wholly or in part, the Fund Office will provide you with a written notice that will include:
- The specific reason(s) for the denial;
- Specific reference to pertinent Plan provisions on which the denial is based;
- A description of any additional information necessary as well as an explanation of why such information is necessary;
- A description of the steps you will need to take if you wish to appeal; and
- A statement of your rights, under ERISA, to bring a civil action after you have exhausted the Plan’s appeal process.
Appeal Procedures
When appealing a claim, you may authorize a representative to act on your behalf. However, you must provide notification to the Fund Office authorizing this representative and comply with the Plan’s procedures.
You or beneficiary, if applicable, may file a written appeal with the Fund Office no later than 60 days after you receive notice that your application for benefits has been denied. You also have a right to review pertinent documents and to submit comments in writing.
You may:
- Submit additional materials, including comments, statements, or documents; and
- Request to review all relevant information (free of charge).
Appeal Decisions
Within 60 days of receipt of your request, the Board of Trustees will complete a new, full, and fair review of your application based on all information available, including any additional information you provide. If special circumstances require an extension, you will be notified within the initial period of the reason for the extension and when you can expect a decision. The initial period may be extended up to an additional 60 days.
After the determination on your appeal is made, you will be sent written notice of the decision. If your claim is denied on appeal, in whole or in part, the notice will include:
- The specific reason(s) for the denial;
- Specific references to the Plan provisions on which the denial is based;
- Notification of your right to access and copy (free of charge) all documents, records and other information relevant to the claim, and
- A statement of your rights, under ERISA, to bring a civil action after you have exhausted the Plan’s appeal process.
The Trustees have full and complete discretion in administering the Plan and the decision of the Board of Trustees is final and binding. No benefits will be paid under the Plan unless the Trustees (or their delegate) determine that a claim for benefits is valid and that the person claiming the benefits is entitled to them. The Trustees’ decision will be given judicial deference in any later court action. You (or any person acting on your behalf) cannot bring a lawsuit against the Plan to recover benefits from the Plan if you do not request a review in accordance with the Plan’s procedures.
Applications for Disability Pensions and Retroactive Terminations of Disability Pensions
You must complete the application form and submit it to the Trustees. The Trustees will approve or deny your application. Unless an extension applies, the Trustees will inform you of their initial decision within 45 days of the date your written application is received.
This initial decision timeframe may be extended for up to two periods of 30 days each, if extra time is needed due to circumstances beyond the Plan’s control (for example, there is a delay in receiving medical information from the physician or other provider). You will be notified before the end of the 45-day period the Plan has to review your application if the first 30-day extension period is needed. If the second 30-day extension period is needed, you will be notified before the end of the first 30day extension period.
If additional information is needed from you, the Trustees will request it from you in writing within the initial 45-day period. You then have 45 days to obtain the requested information (the 45-day period that the Trustees have to make a decision begins on the day the requested information is received or on the last day of the 45day period in which you have to provide the requested information).
Notice of Adverse Determinations
If your application for a disability pension benefit is denied, in whole or in part, you will receive a written notice of the denial from the Trustees that includes the following information.
- The specific reason or reasons for the adverse determination.
- Reference to the specific Plan provision on which the determination is based.
- A description of any additional information that might complete your claim and why this information is necessary.
- A description of the Plan’s review procedures and applicable time limits.
- A statement of your right to bring a civil action under ERISA Section 502(a) of the Act, including the Plan’s applicable time limits for pursuing such action and the date such limits expire.
- Any internal rule, guideline, protocol, or other similar criteria that the Plan relied upon to make the adverse determination; or a statement that such rule, guideline, protocol, standard, or other similar criteria of the Plan do not exist.
- If the adverse benefit determination is based on a medical necessity or experimental treatment, or a similar exclusion or limit—either an explanation of the scientific or clinical judgement for the determination (applying the Plan’s terms to your medical circumstances), or a statement that such an explanation will be provided free of charge upon request.
- A statement that you are entitled to receive, upon request and free of charge, reasonable access to (and copies of) all documents, records, and other information relevant to your claim for benefits.
- An explanation of the basis for disagreeing with or not
following:
- The views you presented to the Plan of the health care and vocational professionals who treated and evaluated you;
- The views of medical or vocational experts whose advice was obtained on behalf of the Plan in connection with your adverse benefit determination, regardless of whether that advice was relied upon in making the benefit determination; and
- A disability determination made by the Social Security Administration that you presented to the Plan.
In addition, the Plan must provide notices and requests in a culturally and linguistically appropriate manner.
Filing an Appeal
To file a written appeal with the Trustees, you have up to 180 days after you receive a notice that your claim is denied or that your disability pension has been retroactively terminated. You may authorize—in writing to the Trustees—a representative to act on your behalf in this matter. The Trustees may delegate their responsibilities to a committee or individuals, including an appeals review committee, and the review will not be made by anyone involved in the initial determination (or anyone subordinate to an individual involved in the initial determination).
If you file a timely written appeal, you
- May submit additional materials, including any comments, statements, or documents.
- May review all relevant information, free of charge, by making a reasonable request to the Trustees. A document, record, or other information is relevant if it:
- Was relied upon by the Plan to make the decision;
- Was submitted, considered, or generated as part of the appeal process (regardless of whether it was relied upon); or
- Demonstrates compliance with the claims processing requirements.
The Appeal Process—A Full and Fair Review on Appeal
The Trustees consider all comments, documents, records, and other information submitted or considered in the initial determination; as well as all subsequent comments and records you submit with your appeal. The appeal cannot defer to the initial claim determination.
If the initial determination is based on medical necessity or appropriateness, the Board of Trustees (or appeals committee) must consult with a medical professional who is not the same person (or his/her subordinate) who was consulted with during the initial review of your claim.
The Trustees will make a determination on your appeal within 45 days after the Trustees’ receipt of your written appeal. The Trustees review all comments, documents, records, and other information you submit related to your claim, regardless of whether you submitted such information—or such information was considered—in the initial determination. You receive a written notice of the Trustees’ decision, which sets forth the specific reasons for the decision as well as references to the pertinent Plan provisions on which the decision is based.
If special circumstances require a delay in the 45-day decision period, the Trustees will notify you in writing of the reason for the extension and do so within the initial 45-day period. A delayed decision on your appeal is made as soon as possible, but no later than 90 days after receipt of the appeal.
If Your Appeal is Denied
If your appeal is denied, in whole or in part, you will receive the Trustees’ written decision that includes the following information.
- The specific reason or reasons for the decision.
- Reference to the specific Plan provision on which the decision is based.
- A statement that you are entitled to receive, upon request and free of charge, reasonable access to (and copies of) all documents, records, and other information relevant to your claim.
- A statement of your right to bring a civil action under ERISA Section 502(a) of the Act, including the Plan’s applicable time limits for pursuing such action as well as the date upon which such limits expire.
- A description of the Plan’s additional voluntary appeal procedures (if any).
- Any internal rule, guideline, protocol, or other similar criteria that the Plan relied upon to make the adverse determination; or a statement that such rule, guideline, protocol, standard, or other similar criteria of the Plan do not exist.
- If the adverse benefit determination is based on a medical necessity or experimental treatment, or a similar exclusion or limit—either an explanation of the scientific or clinical judgement for the determination (applying the Plan’s terms to your medical circumstances), or a statement that such an explanation will be provided free of charge upon request.
- An explanation of the basis for disagreeing with or not
following:
- The views you presented to the Plan of the health care and vocational professionals who treated and evaluated you;
- The views of medical or vocational experts whose advice was obtained on behalf of the Plan in connection with your adverse benefit determination, regardless of whether that advice was relied upon in making the benefit determination; and
- A disability determination made by the Social Security Administration that you presented to the Plan.
In addition, the Plan must provide the notification in a culturally and linguistically appropriate manner.
Before the Trustees issue a denial on an appeal, the Trustees will provide you—free of charge—with any new or additional rationale or evidence considered, relied upon, or generated by the Plan, insurer, or by any other person making the benefit determination. This information is provided as soon as possible and sufficiently in advance of the date on which the notice of your appeal denial is required to be provided to you. This is to give you a reasonable opportunity to respond to this evidence prior to the notification date.
Limitation Period and Required Venue Provisions for Judicial Actions
The Plan has added provisions that judicial actions affecting the Plan or Trustees must be brought in the United States District Court for the Northern District of Illinois, Eastern Division, within one year of either the date of final decision under the Plan's appeal procedures, the date a final decision was required under the appeals procedures if no final decision was made or the date of final Trustee action in a matter not involving a claims appeal. Information regarding this time period and the date the time period expires will be included in all notices of adverse benefit determinations provided by the Plan, both from the Fund Office and on review by the Trustees. The Plan also provides that the standard for review shall be whether the Trustees acted arbitrarily and capriciously.