All claims or disputes concerning eligibility to participate in the Plan, elections made or not made under the Plan, eligibility to receive benefits from the Plan and the amount of benefits received from the Plan, except for Group Term Life Insurance benefits, must be filed with the Administrative Agent. A claim concerning the receipt or denial of benefits from the Group Term Life Insurance Plan must be filed with Standard Insurance Company, 900 SW Fifth Avenue, Portland, OR 97204.

There are two different Claims Appeal Procedures depending on the type of claim at issue. There is a Claims Appeal Procedure for Supplemental Short-Term Disability Benefits and Supplemental Workers’ Compensation Benefits. There is a separate Claims Appeal Procedure for all other types of claims or disputes.

1. Denial, Reduction or Termination of a Supplemental Short-Term Disability or Supplemental Workers’ Compensation Benefit by the Administrative Agent

a. The Administrative Agent, A&I Benefit Plan Administrators, Inc., is responsible for reviewing applications for supplemental short-term disability and supplemental workers’ compensation benefits. The Administrative Agent will provide a notice of benefit determination (whether approved or adverse) within a reasonable period of time but not later than 45 days after receipt of a completed application. If the Administrative Agent determines an extension of time is necessary to complete review of the claim because of matters beyond its control, the 45 day period may be extended for up to 30 days provided the Administrative Agent notifies you of the extension of time for processing the claim during the initial 45 day period. If, prior to the end of the first 30 day extension, the Administrative Agent determines that a further extension of time is necessary to complete review of the claim because of matters beyond its control, the 30 day extension period may be extended for up to an additional 30 days provided that the Administrative Agent notifies you of the extension of time for processing the claim before the end of the first 30 day extension period. If an extension of time is required by the Administrative Agent, you will be notified in writing and the notice shall specify the reason(s) for the extension, the unresolved issue(s), if any, preventing a decision, additional information, if any, needed to resolve the issue(s) and the date a decision is expected.

2. Content of the Denial Notice from the Administrative Agent

a. If your claim is denied, the denial notice will be in writing and will provide:

i. The specific reason or reasons for the decision. If the decision is based on an internal rule, guideline, protocol or other similar criterion, the internal rule, guideline, protocol or similar criterion will be described or provided to you free of charge upon request;

ii. Reference to the specific Plan provision on which the denial is based;

iii. A description of any additional material or information necessary for you to perfect the claim and an explanation why such material or information is necessary; and

iv. A description of the Plan’s review procedures, your right to relevant documents, records and information, the time limits applicable to such procedures and your right to bring a civil lawsuit for the benefit after an adverse determination by the Board of Trustees.

3. Appeal Procedure to the Board of Trustees

a. When a claim has been denied or partially denied by the Administrative Agent, you may appeal the denial to the Board of Trustees.

b. You or your representative have 180 days following receipt of the denial notice from the Administrative Agent to file an appeal with the Board of Trustees. The appeal must be in writing and mailed or delivered as follows:

Harrison Electrical Workers Trust Fund
c/o A&I Benefit Administrators, Inc.
1220 SW Morrison Street
Suite 300
Portland, OR 97205

c. Upon written request, you will be provided free of charge reasonable access to and copies of all documents, records and other information relevant to your claim for benefits. Whether a document, record or other information is relevant to a claim will be determined in accordance with ERISA regulation 29 CFR ¤2560.503-1(m)(8).

d. In conjunction with your appeal, you or your representative may submit written comments, documents, records and other information relating to your claim for benefits to the Board of Trustees.

e. If you request to appear at the hearing before the Board of Trustees at the time your appeal is filed, you will be notified of the time, date and place of the hearing by regular mail at the return address shown on your appeal.

f. You may be represented at the hearing before the Board of Trustees by an attorney or other representative of your choosing at your own cost and expense.

4. Decision by the Board of Trustees

a. Upon receipt of a timely appeal, the Board of Trustees will review the claim de novo (meaning without deference to the initial decision of the Administrative Agent). The Board of Trustees will review all relevant information regardless of whether the information was submitted to the Administrative Agent. If the appeal involves issues of medical judgment, the Board of Trustees will consult a health care professional who has appropriate training and experience in the field of medicine involved in the medical judgment. If the Board of Trustees consult a medical or vocational expert, he will be identified regardless of whether the Board of Trustees rely on his opinion. If the Board of Trustees consults a medical or vocational expert, he will be different than the medical or vocational expert previously consulted and he will not be a subordinate of the medical or vocational expert previously consulted.

b. A decision will be made by the Board of Trustees at its next regularly scheduled meeting following receipt of the appeal unless the appeal is filed less than 30 days prior to such meeting. If this is the case, the Board of Trustees will review the appeal not later than the subsequent Board of Trustees’ meeting. If, due to special circumstances, the Board of Trustees require an extension of time to review the appeal, you will be notified in writing of the special circumstances necessitating the extension and when the decision will be made.

c. The decision of the Board of Trustees will be in writing and sent within five days after the decision is reached.

d. If the Board of Trustees denies your appeal, the decision will be in writing and include the following:

i. The specific reason or reasons for the decision. If the decision is based on an internal rule, guideline, protocol or other similar criterion, the internal rule, guideline, protocol or similar criterion will be described or provided to you free of charge upon request;

ii. Reference to the specific Plan provision on which the denial is based;

iii. A statement that, upon written request, you will be provided free of charge reasonable access to and copies of all documents, records and other information relevant to your claim for benefits. Whether a document, record or other information is relevant to a claim will be determined in accordance with ERISA regulation 29 CFR ¤2560.503-1(m)(8); and

iv. Your right to bring a lawsuit for benefits under ERISA.

e. You are required to use the procedures set forth above before bringing a lawsuit for benefits under ERISA.

f. The Board of Trustees has the full and exclusive authority to administer supplemental short-term disability benefits and supplemental workers’ compensation benefits, interpret this Plan, interpret the Active Employee Plan as it relates to supplemental short-term disability benefits and resolve all questions arising in the administration, interpretation and application of this Plan and the Active Employee Plan that concern supplemental short-term disability and supplemental workers compensation benefits. The Board of Trustees’ authority includes, but is not limited to:

i. The right to resolve all matters when the Claims Appeal Procedure has been invoked;

ii. The right to establish and enforce rules and procedures for the administration of supplemental short-term disability and supplemental workers’ compensation benefits and any claim concerning supplemental short-term disability and supplemental workers’ compensation benefits so long as the rules and procedures are consistent with ERISA;

iii. The right to construe and interpret the Plan and the Active Employee Plan as they relate to supplemental short-term disability and supplemental workers’ compensation benefits; and

iv. The exercise of such power and authority by the Board of Trustees will be given the fullest deference allowed by law.

1. Denial of the Claim by the Administrative Agent

a. The Administrative Agent, A&I Benefit Plan Administrators, Inc. is responsible for reviewing all types of claims except life insurance claims. The Administrative Agent will provide notice of the benefit determination (whether approved or adverse) within a reasonable period of time but not later than 30 days after receipt of the claim. The time period may be extended up to an additional 15 days for matters beyond the Administrative Agent’s control, but you will be notified of the extension before the end of the initial 30 day period. The notice will identify circumstances requiring the extension and the date by which the Administrative Agent expects to issue a decision. If the extension is necessary because you did not submit necessary information, the notice will describe the information required and give you an additional period of at least 45 days to furnish the information. In the event of an adverse benefit determination, you may appeal to the Board of Trustees, who will act on the appeal within the time limits set forth in section 4, below.

2. Content of Denial Notice from the Administrative Agent

a. If your claim is denied, the Denial Notice will be in writing and will provide:

i. The specific reason for the decision;

ii. Reference to the specific Plan provision on which the denial is based;

iii. A description of any additional material or information necessary to perfect the claim and an explanation why such material or information is necessary;

iv. A description of the Plan’s review procedure, the time limits applicable to such procedures, and your right to bring a civil lawsuit for the benefit after an adverse determination by the Board of Trustees;

v. If the denial is based upon an internal rule, guideline, protocol or similar criterion, you will be notified of your right to receive the document free of charge upon request; and

vi. If the denial is based upon a decision involving medical necessity or because the service was experimental or investigational, you will be notified of your right to receive a statement of the scientific or clinical judgment for the decision free of charge upon request.

3. Appeal to the Board of Trustees

a. If you disagree with the initial Denial Notice, you or your authorized representative may file a written appeal within 180 days after receiving the Denial Notice. The written appeal must be filed as follows:

Harrison Electrical Workers Trust Fund
Attn: Appeals Board
c/o A&I Benefit Plan Administrators, Inc.
1220 SW Morrison Street
Suite 300
Portland, OR 97205

b. Upon written request, you will be provided free of charge reasonable access to and copies of all documents, records and other information relevant to your appeal. Whether a document, record or other information is relevant is determined in accordance with 29 CFR ¤2560.503-1(m)(8).

c. In conjunction with your appeal, you or your authorized representative may submit written comments, documents, records or other information relating to your claim to the Board of Trustees.

d. If you or your authorized representative request to appear at a hearing before the Board of Trustees at the time your appeal is filed, you will be notified of the time, date and place of a hearing by regular mail at the return address shown on your appeal.

e. You may be represented at the hearing before the Board of Trustees by an attorney or other authorized representative of your choosing at your own cost and expense.

4. Decision by the Board of Trustees

a. Upon receipt of a timely appeal, the Board of Trustees will review the claim de novo (meaning without deference to the initial decision). The Board of Trustees will review all relevant information regardless of whether the information was previously submitted. If the appeal involves issues of medical judgment such as whether a particular treatment, drug or other item is experimental, investigational or medically necessary, the Board of Trustees shall consult a health care professional who has appropriate training and experience in the field of medicine. If the Board of Trustees consult a health care professional, he will be identified regardless of whether the Board of Trustees rely on his opinion. If the Board of Trustees consult a health care professional, he will be different than the health care professional previously consulted and will not be a subordinate of the health care professional previously consulted.

b. A decision will be made by the Board of Trustees at their next regularly scheduled meeting following receipt of the appeal unless the appeal is filed less than 30 days prior to the meeting. If this is the case, the Board of Trustees will review the appeal not later than the date of the subsequent Board of Trustees’ meeting. If, due to special circumstances, the Board of Trustees requires an extension of time to review the appeal, you will be notified in writing of the special circumstances necessitating the extension and when the decision will be made.

c. The decision of the Board of Trustees will be in writing and sent within five days after the decision is reached.

d. If the Board of Trustees denies your benefit appeal, the decision will include the following:

i. The specific reason for the decision;

ii. Reference to the specific Plan provision on which the decision is based;

iii. A statement that, upon written request, you will be provided free of charge reasonable access to and copies of all documents, records and other information relevant to your claim. Whether a document, record or information is relevant is determined in accordance with 29 CFR ¤2560.503-1(m)(8);

iv. A statement of your right to bring a civil lawsuit for the benefit under ERISA;

v. A statement that any internal rule, guideline, protocol or similar criterion used as a basis for the denial will be available free of charge upon written request; and

vi. A statement that if the decision was based on medical necessity, experimental treatment or other similar exclusions or limitations, the scientific or clinical judgment used in the decision will be provided free of charge upon request.

e. You are required to use the procedures set forth above before bringing a civil lawsuit for the benefit under ERISA.

f. The Board of Trustees has the full and exclusive authority to control and manage the Plan, to administer and interpret the Plan and resolve all questions arising in the administration, interpretation and application of the Plan. The Board of Trustees’ authority includes, but is not limited to:

i. The right to resolve all matters when the Claims Appeal Procedure has been invoked;

ii. The right to establish and enforce rules and procedures for the administration of the Plan and any claim that arises under it so long as the rules and procedures are consistent with ERISA;

iii. The right to construe and interpret the Plan; and

iv. The exercise of such power and authority by the Board of Trustees will be given the fullest deference allowed by law.