If you are not satisfied with the decision concerning your claim for benefits, you have the right to file an appeal. If you choose to file an appeal, complete a Claim Review Request form and submit it to the Fund Office. You must file a written appeal within 180 days from your original benefits determination.
It is important to provide all information requested on the Claim Review Request including:
- Participant’s name and address
- Participant’s identification number
- Patient’s name
- Relationship of patient to participant
- Date of loss
- EXACT reason you are dissatisfied
If the Trust needs any additional material or information from you to process your appeal, we will send you a letter that will describe the information necessary and explain why such information is necessary. If special circumstances require an extension of time to process your appeal, you will be notified by the Fund Office.
If your appeal is denied, you will have the right to bring suit under Section 502(a) of ERISA in an attempt to recover benefits due under the terms of the Plan, enforce rights under the terms of the Plan, or to clarify rights to future benefits under the terms of the Plan.
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. You also have the right to bring an action under Section 502(a) of the Employee Retirement Income Security Act (ERISA).
All requests or questions concerning your appeal should be directed to:
SEIU Local 1 & Participating Employers Health Trust
111 E. Wacker Drive, 17th Floor
Chicago, Illinois 60601