PG&E Voluntary Claims and Appeals Review Process
If you are not satisfied with the claims and appeals review process completed with VSP, you may elect to use PG&E's Voluntary Claims and Appeals Review Process, as described below, or elect to bring a civil action. You have 90 days from the date of receipt of the final decision from VSP to elect this voluntary claims and appeals review process. Initiation of the Voluntary Claims and Appeals Review Process does not restrict your ability to bring a civil action against the Plan.
The first step of the Voluntary Claims and Appeals Review Process is to write to the Benefits Department, requesting a review of your appeal. Your appeal should include all pertinent documentation. To expedite processing, you should also include a HIPAA AUTHORIZATION TO USE AND/OR DISCLOSE PERSONAL HEALTH INFORMATION form. You can access a copy online from the Human Resources Forms section of the PG&E@Work intranet or by calling the PG&E Benefits Service Center at 866-271-8144 (open weekdays from 7:30 a.m. to 5 p.m. Pacific time).
Send your appeal to:
Pacific Gas and Electric Company
Benefits Department
Appeals
1850 Gateway Blvd., 7th Floor
Concord, CA 94520
The Benefits Department will review your appeal and make a decision within 60 days of the date on which the appeal is received (non-receipt of the HIPAA Authorization may delay your appeal). There may be special circumstances where an extension of up to an additional 90 days may be required. You will be notified if such an issue occurs. If the Benefits Department denies your claim, you will receive a written response that will include:
  • the reason(s) for the denial;
  • a reference to the Plan provision(s) which apply to the denial; and
  • an explanation of additional appeals procedures.
You may then have your appeal reviewed by the Employee Benefit Appeals Committee (EBAC). To do so, you must submit a new appeal in writing within 60 days of the date on which you received the Step One denial. Your appeal should state the reason(s) for your appeal and should include all relevant documentation and information supporting your appeal. Unless there are special circumstances where an extension of up to an additional 90 days may be required, you shall receive EBAC's decision within 90 days of EBAC's receipt of the appeal.
Send your appeal to:
Pacific Gas and Electric Company
Benefits Department
EBAC Appeals
1850 Gateway Blvd., 7th Floor
Concord, CA 94520
If EBAC denies your appeal, you will receive a written response which will include:
  • the specific reason(s) for the denial;
  • a reference to the specific Plan provision(s) on which the denial is based;
  • a statement that you are entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records and other information relevant to your claim for benefits; and
  • a statement of your right to bring a civil action under Section 502(a) of ERISA.