Appealing a decision by the KOKO fund

If you are dissatisfied with a decision issued by the KOKO fund, you may appeal it.

You may only appeal a decision made by KOKO, not an advice of payment or a statement issued by a TE Office, for instance. Even if what you disagree with is the TE Office statement, you still have to appeal the decision made by KOKO, not the statement.

You may appeal a decision made by KOKO to the Social Security Appeal Board; and you may appeal a decision made by the Board to the Insurance Court. However, in all cases you must submit your appeal to KOKO, and it will be forwarded to the appropriate authority.

Directions for appeal

An appeal to a decision made by the fund must be submitted in writing and within the appeal period. The appeal must be submitted to the fund within 30 days (Saturdays and Sundays included) from the date you are notified of the decision.

The date of notification of the electronic decision is the date on which you open the decision in the fund’s eService. If you do not open the decision, the decision will be mailed to you. When the decision is mailed to you, the date of notification is the seventh day from the date of mailing.

You must submit your appeal to the fund no later than on the last day of the appeal period.

You can submit the complaint and its possible attachments to the fund either by post or electronically.

When appealing, state the following:

• number of the decision appealed (also include a copy of the decision(s) that you are appealing),
• which points of the decision are you requesting should be changed,
• what changes should be made,
• grounds on which you are appealing,
• your name and contact information (address, phone, and e-mail),
• power of attorney and contact information if someone else is handling this matter on your behalf.

If the decision made by KOKO is based on a statement from a TE Office that is binding upon KOKO, the appeal documents will first be sent to the TE Office for a statement. If the TE Office will not amend its statement, all documents and the statements of the TE Office and KOKO will be submitted to the appellate authority. At this point, you will be sent the documents and statements for your information, and you will have the opportunity to append your statement for direct delivery to the appellate authority. Do not submit this additional statement to KOKO.