The Appeals Process

Appeal Not Related to a Disability Determination

First-Level Appeal

If you, your beneficiary, or any other person (a “claimant”) believes that he or she has been denied benefits under the Plan or the Death Benefit Plan, the claimant may file an appeal with CPF, which will be subject to a full and fair review. A filed appeal must:

  • Be in writing;
  • Be submitted either by the claimant or by his or her authorized representative; and
  • Provide detailed reasons, including any supporting evidence, about why the claimant believes that CPF’s initial decision was incorrect.

You should submit a first-level appeal to:
Church Pension Group
Attn: Appeals – First-Level Review
P. O. Box 2745
New York, NY 10163-2745

The claimant generally will receive a written response to his or her appeal within 60 days after the appeal is received by CPF. If CPF needs additional time (up to 60 days) to review the appeal, the claimant will be notified of the reason(s) for the delay and the anticipated response date, which may not exceed a total of 120 days from the date CPF receives the appeal.

If CPF denies the appeal, in whole or in part, CPF’s written response to the claimant will include:

  • The specific reason(s) for the denial;
  • Specific reference to the applicable plan’s provision(s) on which the denial is based; and
  • A description of the applicable plan’s procedures for filing a second-level appeal.

Second-Level Appeal

Within 60 days following the date the claimant receives CPF’s denial letter for the first-level appeal, the claimant, or his or her authorized representative, may submit a second-level appeal to CPF. (CPF may, in its sole discretion, extend the 60-day period to file a second-level appeal.)

The appeal letter must be in writing and should give a detailed explanation of why the claimant believes the first level appeal should not have been denied. It should also include any other documents or supporting information that may have a bearing on the appeal.

You should submit a second-level appeal to:
Church Pension Group
Attn: Benefit Appeals Committee
P. O. Box 2745
New York, NY 10163-2745

The second-level appeal will be subject to a full and fair review that does not give deference to the determination of the first-level appeal. The claimant will generally receive a written response to his or her second-level appeal within 90 days after it is received by CPF. If CPF needs additional time (up to 90 days) to review the second-level appeal, the claimant will be notified of the reason(s) for the delay and the anticipated response date, which may not exceed a total of 180 days from the date CPF receives the second-level appeal.

If the second-level appeal is denied, CPF’s written response will give the specific reason(s) for the denial and the applicable plan’s provision(s) on which the final denial decision is based.

Appeal Relating to a Disability Determination

First-Level Appeal

All disability claims are reviewed by CPF's Medical Board, Aflac. If Aflac denies your claim, in whole or in part, and you do not agree with Aflac's decision, you, your attorney, or a person legally authorized as your representative may request a review of your claim by filing a first-level appeal. The appeal must be in writing and submitted within 180 days after the date you receive Aflac's denial letter.

Aflac will complete a full and fair review of your appeal. The review will be independent and will not be completed by the person who made the initial decision. Aflac will provide you with a full written explanation of its decision generally within 45 days after its receipt of your first-level appeal. If Aflac needs additional time (up to 45 days) to review your appeal, it will let you know of the extension before the expiration of the first 45 days.

You have the following options to submit a first-level appeal to Aflac:

  • By fax to (800) 206-9186; or
  • Take a photo of or scan your appeal information and upload it to your case at mygrouplifedisability.aflac.com/personal/s/login or send it by email to myPLADSappeal@aflac.com (make sure to include your case number in the subject line of the email); or
  • By mail to:
    Appeals Administrative Office
    PO Box 8308
    Columbus GA 31908-8308

If a disability claim is denied, disability benefits will be suspended. However, if the denial is subsequently overturned, disability benefits will be paid retroactively.

Second-Level Appeal

After Aflac's appeals procedures have been exhausted and the denial determination has been upheld, the claimant, or his or her authorized representative, may submit a second-level appeal to CPF. This must be done within 180 days after the date the claimant receives Aflac's denial letter for the first-level appeal. (CPF may, in its sole discretion, extend the time period to file a second-level appeal.)

The appeal letter must be in writing and should give a detailed explanation of why the claimant believes the first-level appeal should not have been denied. It also should include any other documents or supporting information that may have a bearing on the appeal.

You should submit a second-level appeal to:
Church Pension Group
Attn: Benefit Appeals Committee
P. O. Box 2745
New York, NY 10163-2745

The second-level appeal will be subject to a full and fair review that does not give deference to the determination of the first level appeal. CPF may, in its sole discretion, consult with an independent expert of its choosing when it reviews the second-level appeal.

The claimant will generally receive a written response to his or her second level appeal within 90 days after it is received by CPF. If CPF needs additional time (up to 90 days) to review the second level appeal, the claimant will be notified of the reason(s) for the delay and the anticipated response date, which may not exceed a total of 180 days from the date CPF receives the second-level appeal.

If the second-level appeal is denied, CPF’s written response will give the specific reason(s) for the denial and the applicable plan’s provision(s) on which the final denial decision is based.

After CPF’s Final Determination

Beginning January 1, 2023, if a claimant is not satisfied with CPF’s final determination (of the second-level appeal) and has exhausted the appeals process outlined above, the claimant may contest CPF’s final determination only and exclusively by submitting the matter to arbitration. An arbitrator will be jointly selected by the claimant and CPF from a list of arbitrators supplied by a disinterested third-party alternative dispute resolution (ADR) services provider, as described in more detail in the Plan or Death Benefit Plan, as applicable.

If the denial concerns plan benefits, the claimant must submit the matter to arbitration no later than the earlier of (1) 180 days after receiving CPF’s final determination or (2) two years after the date on which the claimant knew or should have known the material facts on which the dispute is based. In all other cases (for example, a denial of eligibility to participate), the claimant must submit the matter to arbitration no later than two years after the earliest date the claimant knew or should have known the material facts on which the dispute is based.

In addition, by participating in the Plan or the Death Benefit Plan, or by seeking or receiving any benefit under the Plan or the Death Benefit Plan, a claimant waives the right to commence, be a party to, or be an actual or putative member of any class, collective, or representative action arising out of or relating to such plan. As such, any claim must be brought on an individual basis only, and a claimant may not seek or receive any remedy that has the purpose or effect of providing additional benefits or monetary relief to any other claimant, participant, or beneficiary.

A Guide to the Lay Defined Benefit Plan (PDF)
Guide to Lay Defined Benefit Plan Disclaimer

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