§ 16-112. Claims. notices and inquiries.

(a)

Claims, notices and inquiries. All claims for benefits, elections for a specific form of benefit, notices of re-employment, notices of re-retirement, verifications of retirement, notices of mailing address, notices of appeal, and all other inquiries and matters concerning the pension plan shall be submitted to the board of trustees addressed as follows:

Finance Director
City of Cocoa Beach
Cocoa Beach General Employees' Pension Trust Fund
2 South Orlando Avenue
Cocoa Beach, Florida 32931

(b)

Response to claims and inquiries. All inquiries shall be answered promptly. The final decision for approval of benefits shall be made by the trustees.

(c)

Denial of benefits. If any claim for benefits is denied, suspended, or terminated, in whole or in part, then the claimant shall be furnished with a notice of denial, suspension or termination no later than thirty (30) days after the final decision has been made. The notice shall be provided in writing, by certified mail, and shall set forth:

(1)

the specific reasons for the denial, suspension or termination of benefits; and

(2)

the specific references to the pertinent provisions of the pension plan upon which the action is based and a copy of the pension plan provisions shall be furnished with this notice; and

(3)

a description of any additional material or information necessary for the claimant to perfect the claim, along with an explanation of why such material or information is necessary; and

(4)

an explanation of the claims review procedure.

(d)

Claims review procedure.

(1)

Requests for review. If a claim for benefits is denied, suspended or terminated, in whole or in part, then the claimant may appeal to the trustees for a full and fair review. In order to file an appeal, a written notice of appeal must be submitted within sixty (60) days after the notice of denial, suspension or termination is received by the claimant (or such later time as the trustees deem reasonable). The notice of appeal shall briefly describe the grounds upon which the appeal is based on shall be signed by the claimant. The claimant shall be allowed to review all pertinent documents during normal business hours, and shall be permitted to submit comments and a statement of issues for consideration by the trustees.

(2)

Representation. A claimant may designate an attorney, or any other duly authorized person, to act as their representative at any stage of the claims review procedure. Any rights provided to the claimant during the claims review procedure shall automatically extend to the representative designated by the claimant. A designation of representative shall be signed by the claimant and the representative, and shall be submitted in writing.

(3)

Claims review board. The trustees shall rule on all appeals brought under this section. A decision to grant or deny an appeal shall be based solely on the record before the board of trustees, unless the trustees determine, in their sole discretion, that a hearing is necessary for the proper resolution of the appeal. The trustees shall decide to grant or deny an appeal, the final decision shall be made by the trustees, in writing, and shall be made no later than sixty (60) days after receipt of the notice of appeal, unless special circumstances (such as the need for a hearing) require an extension of time. In no event, however, should the decision of the Trustees be made later than one hundred twenty (120) days after receipt of the notice of appeal. If an appeal is denied, in whole or in part, then the decision shall set forth the specific reasons for the action, with specific references to those pension plan provisions upon which the decision is based. The claimant shall be promptly provided with a copy of this decision. The decision of the trustees shall be final and binding.

(e)

Exhaustion of claims review procedure. No action in law or in equity shall be brought to contest a denial, suspension or termination of benefits until the claimant has complied with the procedures provided in section 16-112(d) (claims review procedure), unless the trustees fail to render a decision within one hundred twenty (120) days after receipt of the notice of appeal. In no case, however, shall any action be brought unless instituted within one (1) year from the time the claimant received the notice of denial, suspension, or termination provided in section 16-112(c) (denial of benefits).

(Ord. No. 1222, § 1, 11-18-1999)