The Appeals Process

Appeal Relating to a Disability

First Level Appeal

If an appeal relates to whether or not a claimant is disabled under the Plan, the first level appeal should be submitted to the Medical Board, Zurich. Zurich will provide a description of its appeals procedures if and when a disability claim is denied.

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 Zurich’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 Zurich’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
P. O. Box 2745
New York, NY 10163-2745
Attn: Benefit Appeals Committee

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

A claimant may not file a civil suit until he or she has exhausted the appeals procedures outlined above. If a claimant is not satisfied with CPF’s final determination (of the second level appeal), the claimant must file a civil suit within 180 days after receiving CPF’s final determination. As a participant or beneficiary in a CPF benefit plan, the claimant has consented to the venue and exclusive jurisdiction of the courts located in New York City. Therefore, any civil action must be filed in New York City.