Medical Appeals Process Sample Clauses

Medical Appeals Process. If your application for disability benefits is denied at the onset on the basis of medical evidence, you can appeal that decision by submitting new medical evidence within three (3) months of the initial decline letter. After you have followed this appeal process for declined claims and Manulife is satisfied that all available medical documentation has been submitted but our decision has not changed, you will be offered MAP (Medical Appeals Process) for final resolution of the claim. First, you will be asked to sign an agreement and authorization form to continue on with this process. Then, you will appoint a physician to act on your behalf. Manulife's Medical Director or designate will act on Manulife's behalf. The two (2) physicians will jointly choose a third independent physician to review all available medical and functional evidence and undertake additional tests or examinations, as deemed necessary. The decision of the independent physician to admit the claim or to maintain the decline is binding on you, Manulife and the Employer, and no further action can be taken. If the decision is to admit your claim, Manulife still has the right to periodic reviews of your condition to determine continuation of your benefits. The cost of the MAP process will be charged to the plan.
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Medical Appeals Process. If your application for disability benefits is denied at the onset on the basis of medical evidence, you can appeal that decision by submitting new medical evidence within three (3) months of the initial decline letter. After you have followed this appeal process for declined claims and Manulife is satisfied that all available medical documentation has been submitted but our decision has not changed, you will be offered MAP (Medical Appeals Process) for final resolution of the claim. First, you will be asked to sign an agreement and authorization form to continue on with this process. Then, you will appoint a physician to act on your behalf. Manulife's Medical Director or designate will act on Manulife's behalf. The two
Sample 1
Medical Appeals Process. If a claim for long-term disability is denied, the employee must fully comply with the carrier’s Medical Appeal Process prior to filing a grievance, provided that the process is completed within days of its inception, unless that time is extended by mutual agreement of the Hospital and Hospitals of Ontario Pension Plan All full-time staff shall join the Hospitals of Ontario Pension Plan, in accordance with the terms and conditions of the plan.
Sample 1
Medical Appeals Process. If a claim for long-term disability is denied, the employee must fully comply with the carrier’s Medical Appeal Process prior to filing a grievance, provided that the process is completed within sixty (60) days of its inception, unless that time is extended by mutual agreement of the Hospital and SEIU local 1.on Paramedical Unit effective date of ratification.
Sample 1

Related to Medical Appeals Process

  • Appeals Process A. The Contractor’s appeal process shall, at a minimum:

  • Legal Appeals a. Nothing contained in these provisions is intended to limit or impair the rights of any vendor or Contractor to seek and pursue remedies of law through the judicial process. Appendix C Appendix C, Contract Modification Procedure, attached hereto, is hereby expressly made a part of this Contract as fully as if set forth at length herein. Appendix D Appendix D, Pricing Schedules, attached hereto, is hereby expressly made a part of this Contract as fully as if set forth at length herein. The Parties expressly agree that these prices are established as “maximum Not-To-Exceed prices”. The Contractor acknowledges that any mini-bid under this Centralized Contract which includes pricing in excess of the “maximum Not-To-Exceed price” shall be rejected by the Authorized User. Amendments to Appendix D, Pricing Schedules, shall be processed in accordance with Appendix C, Contract Modification Procedure, section 4.8, OGS Centralized Contract Modifications and section 4.23 Price Adjustments for OGS Centralized Contracts. Appendix E Appendix E, Report of Contract Purchases, attached hereto, is hereby expressly made a part of this Contract as fully as if set forth at length herein. OGS reserves the right to make unilateral changes to this Report of Contract Purchases document. Appendix F Appendix F, Project Based Information Technology Consulting Services Processes and Forms, attached hereto, is hereby expressly made a part of this Contract as fully as if set forth at length herein. OGS reserves the right to change the processes and forms set forth Appendix F in non-material and substantive ways without seeking a contract amendment. Appendix F is comprised of the following attachments:

  • Claims Process (1) In order to seek payment from the Settlement Amount, a Class Member must submit a completed Claim Form to the Administrator, in accordance with the provisions of the Plan of Allocation, on or before the Claims Bar Deadline and any Class Member who fails to do so shall not share in any distribution made in accordance with the Plan of Allocation unless the relevant court orders otherwise as provided in section 18.4.

  • Appeals Procedure If Employee appeals to the Administrator, Employee or his authorized representative may submit in writing whatever issues and comments he believes to be pertinent. The Administrator shall reexamine all facts related to the appeal and make a final determination of whether the denial of benefits is justified under the circumstances. The Administrator shall advise Employee in writing of:

  • PROFESSIONAL DEVELOPMENT AND EDUCATIONAL IMPROVEMENT A. The Board agrees to implement the following:

  • Clinical 2.1 Provides comprehensive evidence based nursing care to patients including assessment, intervention and evaluation.

  • Grievance and Appeals Unit See Section 9 for contact information. You may also contact the Office of the Health Insurance Commissioner’s Consumer Resource Program, RIREACH at 1-855-747-3224 about questions or concerns you may have. Complaints A complaint is an expression of dissatisfaction with any aspect of our operation or the quality of care you received from a healthcare provider. A complaint is not an appeal. For information about submitting an appeal, please see the Reconsiderations and Appeals section below. We encourage you to discuss any concerns or issues you may have about any aspect of your medical treatment with the healthcare provider that furnished the care. In most cases, issues can be more easily resolved if they are raised when they occur. However, if you remain dissatisfied or prefer not to take up the issue with your provider, you can call our Customer Service Department for further assistance. You may also call our Customer Service Department if you are dissatisfied with any aspect of our operation. If the concern or issue is not resolved to your satisfaction, you may file a verbal or written complaint with our Grievance and Appeals Unit. We will acknowledge receipt of your complaint or administrative appeal within ten (10) business days. The Grievance and Appeals Unit will conduct a thorough review of your complaint and respond within thirty (30) calendar days of the date it was received. The determination letter will provide you with the rationale for our response as well as information on any possible next steps available to you. When filing a complaint, please provide the following information: • your name, address, member ID number; • the date of the incident or service; • summary of the issue; • any previous contact with BCBSRI concerning the issue; • a brief description of the relief or solution you are seeking; and • additional information such as referral forms, claims, or any other documentation that you would like us to review. Please send all information to the address listed on the Contact Information section.

  • Medical Appointments Medical appointments may be charged to sick leave, provided the minimum time charged is not less than one-half (1/2) hour. Each absence shall be reported separately and authorized in advance by the employee's immediate supervisor.

  • Review Process A/E's Work Product will be reviewed by County under its applicable technical requirements and procedures, as follows:

  • Complaints Process The School shall establish and adhere to a process for resolving public complaints which shall include an opportunity for complainants to be heard. The final administrative appeal shall be heard by the School's Governing Board, except where the complaint pertains to a possible violation of any law or term under this Contract. The complaints process shall be readily accessible from the School’s website, as described in Section 11.4.1.

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