Left Navigation

 

The Appeals Process

Appeal Not Related to a Disability

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
P. O. Box 2745
New York, NY 10163-2745
Attn: Appeals – First Level Review

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.

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 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

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, Liberty Mutual. Liberty Mutual 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 Liberty Mutual’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 Liberty Mutual’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.

Appeal Relating to a Disability

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.

After CPF’s Final Determination