Mo. Code Regs. tit. 16 § 50-1.020

Current through Register Vol. 49, No. 23, December 2, 2024

Section 16 CSR 50-1.020 - Appeal Process

PURPOSE: This rule establishes formal procedures for appeals to the board of directors.

(1) Members, beneficiaries and surviving spouses may request review by the board of directors of decisions by the board or its designee concerning eligibility for and the amount of benefits, service, contributions, refunds and membership.

(2) Requests.

(A) The request for review must be stated in writing, addressed to the plan administrator. The request must state what decision the board is being asked to review, and what action the board is being asked to take.

(B) The request must be made within sixty (60) days after the administrative decision has been mailed or otherwise communicated to the party making the request for review.

(3) The review will be conducted at the next regularly scheduled meeting of the board of directors which is at least thirty (30) days after the request for review is received. The party requesting review (the appellant) will be notified in writing of the date the board will conduct the review. All reviews will be conducted in Jefferson City, Missouri.

(4) The plan administrator will prepare background material for the board, which will include documentation necessary for the board to review the decision. The background material will be provided to the appellant at the same time that it is provided to the board. Any requirements of law prohibiting reproduction or distribution of material will be observed.

(5) Reviews.

(A) Reviews will be held on an informal basis and no formal rules of evidence will be applied.

(B) The appellant may present additional documentation and testimony for the board to consider. Attendance by the appellant is not required, however, and the appellant may submit the additional information without being present at the meeting. Nonappearance by the appellant at the meeting will not adversely affect the board's consideration of the request.

(C) The appellant is encouraged to provide any documentation at least one (1) week prior to the meeting so it can be distributed to the board before the meeting.

(6) The appellant may be represented by counsel at the review. The appellant may present witnesses to the board who can provide information to the board. The chair retains discretion to limit the number of witnesses appearing before the board. The chair also retains discretion to require testimony to be limited only to the subject of the request for review.

(7) The board will consider the background material, the appellant's information and any relevant legal materials, and make its decision no later than the next regularly scheduled meeting.

(8) The decision of the board will be communicated to the appellant in writing by its legal counsel.

(9) Any party adversely affected by the decision may seek judicial review under the provisions of Chapter 536, RSMo.

16 CSR 50-1.020

AUTHORITY: section 50.1032, RSMo Supp. 1999.* Original rule filed Oct. 11, 1995, effective May 30, 1996. Amended: Filed Sept. 9, 1997, effective Feb. 28, 1998. Amended: Filed Sept. 29, 2000, effective March 30, 2001 .

*Original authority: 50.1032, RSMo 1995.