Appeals of Eligibility and/or Award Determinations Clause Samples

Appeals of Eligibility and/or Award Determinations. 5.4.1 Unless otherwise agreed between HOC and the respective Qualified Claimant, or his/her Principal Responsible Attorney, within thirty (30) days following service of any notice of the Claims Processor under Section 5.3 regarding a Claimant’s Eligibility and/or Award Determinations (with the exception of determinations as to deficiencies as set forth in Section 4.5.1), an Enrolled Claimant or his/her Principal Responsible Attorney may appeal the Determination to one (1) of the Special Masters by serving on the Claims Processor a form of appeal (to be agreed upon by the Parties). Within thirty (30) days following (unless otherwise agreed to by the SOC or by application by HOC to the Claims Administrator) receipt of the notice of appeal, and excluding Enhancements claims for lost wages the Claims Processor will review the claim before sending it to one (1) of the Special Masters to determine if the Claims Processor agrees with the appeal. If the Claims Processor agrees with the Settlement Program Claimant’s position, the Claims Processor will issue an amended determination notice, which will then provide the Settlement Program Claimant a new period to consider an appeal. If the Claims Processor does not agree with the Settlement Program Claimant’s position on appeal, such appeal shall be directed to one (1) of the Special Masters. If an Enrolled Claimant or his/her Principal Responsible Attorney does not timely serve an appeal pursuant to this Section 5.4.1, the Claims Processor’s determination is final, binding, and Non-Appealable, absent a decision by HOC to the contrary pursuant to Section 5.1.3. 5.4.1.1 With respect to any timely appeal under Section 5.4.1, the Special Master will review, for an abuse of discretion, whether the Enrolled Claimant meets the eligibility requirements for status as a Settlement Program Claimant based solely on (1) the Claim Package and/or EBP Claim Package before the Claims Processor when it issued the Eligibility and/or Award Determination, (2) any Additional Claim Information provided by that Claimant to the Claims Processor prior to the issuance of the Claims Processor’s Eligibility and/or Award Determination, and (3) the terms of this Agreement. No new or additional evidence may be submitted or considered in connection with any appeal.