As a member of the USW 8782 Retiree Benefits Trust, you are entitled to comprehensive benefits, including health, vision and dental coverage, as well as life and travel insurance. But, sometimes claims are denied either partially or fully.

If this happens, and you disagree with the reason or reasons provided:

• You (and your covered dependants) have the right to appeal the interpretation of the plan terms and benefits determinations.
• You must start the process within 90 days of the claim decline date.
• You can only appeal a claim settlement decision once.

1. Before starting an appeal, please check your benefits booklet details and/or call the insurer for clarification of any denied claim. A representative can assist you in understanding your benefits coverage, provide reasons why certain benefits may not be covered and/or explain additional information that may be needed to have the claim reviewed.

2. If you want to appeal the decision, you should first contact the insurer and go directly through their internal process:

3. If your appeal from the insurer is denied, then you can submit a written appeal to the Appeals Committee by completing and submitting this Appeal Form.

4. The Appeals Committee will review your claim, and either:

• make a recommendation to the Board of Trustees, or
• let you know that the claim decision will stand as is.

5. The Board will make a decision, if necessary, and inform you of that decision in writing.

NOTE: You may be asked to provide extra information or documentation as part of your appeal. You are responsible for all costs related to providing this information.