Benefit Claims and Legal Actions
If your application for benefits is denied in whole or in part, the Administrator will write to you explaining the reasons for the denial and tell you how you can appeal the decision. You have the right to have the Plan review and reconsider your claim. The appeals procedures are fully described below. After exhausting all of the remedies available to you through
normal channels; that is, after your claim for benefits is denied and your appeal is denied, you may in many cases (with the assistance of your local) seek arbitration of your claim, in accordance with the
Collective Bargaining Agreement or you may take your case to court. Under ERISA, there are steps you can take to enforce the above rights. For instance, if you have a claim for benefits which is denied or ignored, in whole or in part, or if you discover that a Plan fiduciary is
misusing the Plan’s money or if you are discriminated against for exercising your rights under ERISA, you may file suit in a
federal court or ask the U.S. Department of Labor for help. If you make a written request for material required to be given to you and you do not receive the material within 30 days after your request, you may bring suit as long as the delay in getting the material to you is not beyond the control of the Administrator. (In this instance, the court may require the Trustees to pay you up to $100.00 for each day’s delay.)
If you bring suit in federal or state court to protect any of the ERISA rights that have been discussed above, the court will decide who will pay court costs and legal fees. If you are successful the court may ask that these costs and fees be paid by the losing party. On the other hand, if you are not successful the court may order you to pay these costs and fees.
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Appeal of a Denied Claim
The Board of Trustees hears all disputes and grievances arising out of the various HRSA-ILA Funds. If you have a
grievance in connection with your
benefits you must contact the Administrator within sixty (60) days
following the calendar quarter in which the problem or incident occurred. The calendar quarters end on March 31, June 30, September 30, and December 31. If your benefits are denied, you will receive written notice setting forth the specific reasons for the denial.
If the Administrator is unable to resolve your grievance, you may request a review of the denial by the Board of Trustees. You or your union representative must file a written grievance with the Board of Trustees. The Board of Trustees will
generally act upon your grievance within 90 days of receipt. After the Board of Trustees has met you will receive written
notification of the Board’s decision on your grievance.
If the decision is not favorable, you will be notified of the reasons for the denial with specific reference to the appropriate plan provisions that apply. The Board of Trustees will also tell you how you can appeal this decision.
If you wish to appeal the Board’s decision, then you or your union representative must file your grievance with the Trustee Arbitration Committee of the Hampton Roads Shipping Association and the International Longshoremen’s Association as provided for in your Collective Bargaining Agreement. Decisions reached by the Trustee Arbitration Committee are final and binding.
In the event that the Trustee Arbitration Committee is unable to reach a decision, application will be made to the Federal Mediation and Conciliation Service for a final determination of the questions.
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