§ 54-136. Claims, notices and inquiries.

(a)

Submission. All claims for benefits, elections for a specific form of benefit, notices of re-employment, notices of re-retirement, verifications of retirement, notices of mailing address, and notices of appeal, and all other inquiries and matters concerning the pension plan, shall be submitted to the board of trustees.

(b)

Response to claims and inquiries. All inquiries shall be answered promptly. The final decision for approval of benefits shall be made by the board of trustees.

(c)

Denial of benefits. If any claim for benefits is denied, suspended or terminated, in whole or in part, then the claimant shall be furnished with a notice of denial, suspension or termination no later than 30 days after the final decision has been made. The notice shall be provided in writing, by certified mail, and shall set forth:

(1)

The specific reasons for the denial, suspension or termination of benefits;

(2)

The specific references to the pertinent provisions of the pension plan upon which the action is based, and a copy of the pension plan provisions shall be furnished with this notice;

(3)

A description of any additional material or information necessary for the claimant to perfect the claim, along with an explanation of why such material or information is necessary; and

(4)

An explanation of the claims review procedure.

(d)

Claims review procedure.

(1)

Request for review. If a claim for benefits is denied, suspended or terminated, in whole or in part, then the claimant may appeal to the board of trustees for a full and fair review. In order to file an appeal, a written notice of appeal must be submitted within 60 days after the notice of denial, suspension or termination is received by the claimant, or such later time as the board of trustees deems reasonable. The notice of appeal shall briefly describe the grounds upon which the appeal is based and shall be signed by the claimant. The claimant shall be allowed to review all pertinent documents during normal business hours, and shall be permitted to submit comments and a statement of issues for consideration by the board of trustees.

(2)

Representation. A claimant may designate an attorney, or any other duly authorized person, to act as his representative at any stage of the claims review procedure. Any rights provided to the claimant during the claims review procedure shall automatically extend to the representative designated by the claimant. A designation of representative shall be signed by the claimant and the representative, and shall be submitted in writing.

(3)

Claims review board. The board of trustees shall rule on all appeals brought under this subsection. A decision to grant or deny an appeal shall be based solely on the record before the board of trustees, unless the board of trustees determines, in its sole discretion, that a hearing is necessary for the proper resolution of the appeal. The board of trustees shall decide, by majority vote, to grant or deny an appeal. The final decision shall be made by the board of trustees, in writing, and shall be made no later than 60 days after receipt of the notice of appeal, unless special circumstances (such as the need for a hearing) require an extension of time. In no event, however, should the decision of the board of trustees be made later than 120 days after receipt of the notice of appeal. If an appeal is denied, in whole or in part, then the decision shall set forth the specific reasons for the action, with specific references to those pension plan provisions upon which the decision is based. The claimant shall be promptly provided with a copy of this decision. The decision of the board of trustees shall be final and binding, and shall not be subject to the grievance or arbitration procedure established in any collective bargaining agreement between the city and any labor organization.

(e)

Exhaustion of claims review procedure. No action in law or in equity shall be brought to contest a denial, suspension or termination of benefits until the claimant has complied with the procedures provided in subsection (d) of this section, unless the board of trustees fails to render a decision within 120 days after receipt of the notice of appeal. In no case, however, shall any action be brought unless instituted within one year from the time the claimant received the notice of denial, suspension or termination provided for in subsection (c) of this section.

(Ord. No. 1993-43, § 16, 9-28-93; Ord. No. 1994-12, § 6, 5-3-94)