Adverse Determination. The IRO shall provide notice of its decision to uphold or reverse the Adverse Determination or Final Adverse Determination to the Plan, the Director and you: as expeditiously as your medical condition or circumstances require, but no more than 72 hours after the receipt of request. External Review of Experimental or Investigational Treatment Experimental or Investigational Treatment External Review Timing You may file a request with the Director for an external review after receipt of an Adverse Determination or a Final Adverse Determination within: 4 months after date of receipt If your treating Physician certifies in writing that the recommended or requested health care service or treatment would be significantly less effective if not promptly initiated, you may make an oral request for an expedited external review, after which the Director shall immediately notify the Plan and the time frames otherwise applicable to Expedited External Review shall apply. After the receipt for an external review, the Director shall send a copy of the request to the Plan within: one business day The Plan shall complete a preliminary review of the request within: 5 business days After completion of the preliminary review, the Plan shall notify you and the Director whether the request is complete and eligible for external review within: one business day When the Director receives notice that the request is eligible for external review, the Director shall: assign an IRO and notify the Plan of the name of the IRO, within: one business day notify you of the request's eligibility and acceptance for external review and the name of the IRO, within: one business day If you are notified that your request for an external review has been accepted, you must submit additional information to the assigned IRO within: 5 business days The assigned IRO shall then select one or more clinical reviewers within: one business day The Plan shall provide to the assigned IRO the documents and any information used in making the Adverse Determination or Final Adverse Determination within: 5 business days of notice of assigned IRO After being selected by the assigned IRO, each clinical reviewer shall provide an opinion to the assigned IRO on whether the recommended or request health care service shall be covered within: 20 days Experimental or Investigational Treatment External Review Timing or, in the case of an expedited external review: immediately, but in no event more than 5 calendar days The ass...
Adverse Determination. In the event the trust arrangement created hereby is deemed to be invalid or ineffective as a trust by a court of competent jurisdiction, whether in connection with the bankruptcy of one of the parties hereto or otherwise (an “Adverse Determination”), then the parties agree that the nature of their relationship shall be Grantor as debtor, Trustee as securities intermediary and Beneficiaries’ Representative as secured party for the benefit of the Beneficiaries. To that end, and to secure the obligation of Grantor to indemnify Beneficiaries, Grantor hereby grants the Beneficiaries’ Representative for the benefit of the Beneficiaries a continuing security interest in, and pledges all right title and interest in and to, the following (for purposes of this Section 4.12, the “Collateral”):
Adverse Determination. Any indemnification under Sections 3 and 4 --------------------- hereof shall be paid by the Company in accordance with Section 8 unless (i) a determination is made that indemnification is not proper because the Indemnitee has not met the applicable standard of conduct set forth in Sections 3 and 4, or (ii) with respect to indemnification under Section 4, the Indemnitee shall have been adjudged to be liable to the Company, and the court in which such Proceeding is or was pending has determined upon application that, in view of all the circumstances of the case, the Indemnitee is not entitled to indemnity. The determination set forth in (i) above shall be made no later than the end of the thirty-day period set forth in Section 8.2 by any of the following: (1) with respect to a person who is a director or officer at the time of such determination (a) by a majority vote of the directors who are not parties to such Proceeding, even if less than a quorum, (b) by a committee of such directors designated by majority vote of such directors, even though less than a quorum, (c) if there are no such directors or if such directors so direct, by a written opinion of independent legal counsel, or (d) by approval of the Company's stockholders with the shares owned by the Indemnitee not being entitled to vote thereon or (ii) with respect to employees and agents who are not directors or officers at the time of such determination, by any person or persons having corporate authority to act on the matter, including the foregoing authorized persons, or (iii) with respect to all employees and agents whether or not such employees and agents are officers or directors of the Company at the time of such determination, by the court in which such Proceeding is or was pending, if such is the case, upon application made by the Company or the Indemnitee or the attorney or other person rendering services in connection with the defense, whether or not such application by the Indemnitee, attorney or other person is opposed by the Company.]
Adverse Determination. When the claims administrator reviews an admission, availabil- ity of care, continued stay, or other health care service and decides that it is not medi- cally necessary, appropriate, or effective. Therefore, payment for the requested service is denied, reduced, or terminated.
Adverse Determination. If, after the Effective Date of this Agreement, FERC or any other regulatory body, agency or court of competent jurisdiction determines that all or any part of this Agreement, its operation or effect, is unjust, unreasonable, unlawful, imprudent or otherwise not in the public interest, each Party shall be relieved of any obligations hereunder to the extent necessary to comply with or eliminate such adverse determination. The Parties shall promptly enter into good faith negotiations in accordance with Section 4.4 (Renegotiation) in an attempt to achieve a mutually agreeable modification to this Agreement to address any such adverse determination.
Adverse Determination. SelectCare shall be responsible for notifying Members of non-Covered Services. Member notification shall be made in writing, with a copy to Provider, that indicates the decision to deny services made by SelectCare. If the Member elects not to comply with such writing and the requirements of SelectCare, Provider will xxxx Member directly under Section 5.6, hereof.
Adverse Determination. HPN or Payer shall be responsible for notifying Members of non-Covered Services. Member notification shall be made in writing, with a copy to Provider, that indicates the decision to deny services made by HPN. If the Member elects not to comply with such writing and the requirements of HPN, Provider will xxxx Member directly under Section 6.6, hereof.
Adverse Determination. In case the Trustee or the Issuer shall have proceeded to enforce its rights under this Financing Agreement and such proceedings shall have been discontinued or abandoned for any reason or shall have been determined adversely to the Trustee or the Issuer, then, and in every such case, the Company, the Trustee and the Issuer shall be restored respectively to their several positions and rights hereunder, and all rights, remedies and powers of the Company, the Trustee and the Issuer shall continue as though no such action had been taken.
Adverse Determination. Notwithstanding any other provisions of this Agreement or of the Trust Certificates or any other Operative Agreement, if at any time any Trust Certificate Purchaser or Certificate Holder shall in good faith make an Adverse Determination, such Trust Certificate Purchaser or Certificate Holder shall promptly notify the Lessor Trustee and the Lessee thereof and from and after the date specified in such notice the Trust Certificates held by such Trust Certificate Purchaser or Certificate Holder shall bear interest at the Alternate Rate. Any determination made by a Trust Certificate Purchaser or Certificate Holder shall, absent manifest error, be final and conclusive and binding upon all parties.
Adverse Determination. Notwithstanding anything stated to the contrary in this Agreement, if at any time, as a result of a Final Determination, a tax is payable by Executive, his beneficiary or his estate in respect of any amount credited to the Deferral Account prior to payment under the terms of this Agreement, then Tiffany shall pay to Executive the amount of such tax and the Deferral Account balance, or, in the event Annuity Payments are then being paid, future Annuity Payment, shall be reduced by the amount of such tax. For the purposes of this Section 9., the term "Final Determination" means (i) an assessment of tax by the United States Internal Revenue Service addressed to the Executive or his beneficiary which is not timely appealed to the courts; (ii) a final determination by the United States Tax Court or any other Federal Court, the time for an appeal thereof having expired or been waived; or (iii) an opinion by Tiffany's counsel, addressed to Tiffany and in form and substance satisfactory to Tiffany, to the effect that amounts credited to the Deferral Account are subject to Federal income tax to the Executive or his beneficiary prior to payment under the terms of this Agreement. No Final Determination shall be deemed to have occurred until Tiffany has actually received a copy of the assessment, court order or opinion which forms the basis thereof and such other documents as it may reasonably request.
