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SECTION 2.0 - GENERAL CLAIM PROCEDURES

  1. Filing Claims: All claims must be filed within 90 days after the claim has arisen. Claim forms may be obtained from the Fund Office.

  2. Claim Forms: The Trustees, upon receipt of a notice of claim, will furnish to the claimant, such forms as are usually furnished by it for filing Proof of Loss. The Trustees shall have been deemed to have supplied such forms upon mailing such forms to the last known mailing address of the eligible participant as recorded in the Fund Office records.

  3. Proof Of Loss: Written Proof of Loss must be furnished to the Trustees within 90 days from the date of loss. Proof of Loss shall consist of the Completed Claim Form, together with all itemized bills or other documents called for under the Plan, signed and certified to by the claimant or in the case of death, his or her beneficiary.


    Failure to furnish notice or proof within the time provided in this plan shall not invalidate nor reduce any claims if it shall be shown that such notice or proof was furnished as soon as was reasonably possible.

  4. Payment Of Claims: Disability Benefits under this plan will be paid directly to the eligible participant. In no event may the participant assign Death, Accidental Death Benefits or Weekly Disability Benefits under this plan.


    In the event that benefits are payable to an eligible participant who is deceased, then the benefits will be paid to the named beneficiary, if living. If the beneficiary shall have pre-deceased the eligible participant, then the benefits shall be payable to the first surviving class of the following classes of successive beneficiaries:

    1. widow or widower
    2. surviving children
    3. surviving parents
    4. surviving brothers and sisters
    5. executors or administrators
  5. Errors In Benefit Payments: The Trustees specifically retain the right to recover all monies paid in error to, or in behalf of any person, from such person. Upon the discovery of a payment "made in error," the Trustee shall notify the recipient or beneficiary of such payment, indicating the circumstances and amount of such payment, together with a request for re-payment. Upon failure to repay the amount due within a reasonable time after such notification, the Trustees may take such legal action as they deem necessary, or in the case of a participant of the Fund, the amount of the payments made in error may be deducted from any future benefit payments which such participant or his dependents or beneficiary may become entitled to under this plan.

  6. Fraud: Any person attempting to submit false, misleading or incomplete information, or who in any way attempts to defraud the Fund, may be prosecuted in such manner as the Trustees deem advisable.

  7. Filing Claims Under The Preferred Blue PPO Program: Please consult the documentation provided by the PPO Blue Program for information regarding filing for claims. For the most part, the PPO Blue Program does not require you to file for claims. Your Primary Care Physician and your referral providers will file your claims directly with Highmark Blue Cross and Blue Shield.