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 Clergy Pension Plan or any other benefit plan described in this Guide, 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 by either the claimant or 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.

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. 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) 206-4063; or
• Take a photo of or scan your appeal information and upload it to your case at https://mygrouplifedisability.aflac.com or send it by email to myzurichleave@zurichna.com (make sure to include your case number in the subject line of the email); or
• By mail to:
  Aflac
  PO Box 1725
  Grand Rapids, MI 49501

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 the following number of days after the date the claimant receives Aflac's denial letter for the first-level appeal:

• For a short-term disability appeal, 60 days
• For all other disability appeals, 180 days

(CPF may, in its sole discretion, extend the time period to file a second-level appeal.)

The appeal 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.

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.