Strict Adherence by Company Sample Clauses

Strict Adherence by Company. If for any reason the Company fails to strictly adhere to these appeal procedures as required by state or federal law, the Insured shall be deemed to have exhausted the internal claims and appeals process regardless of whether the Company asserts it substantially complied with appeals procedures or committed any de minimis error. Form CG-227 1/18 A. Company's Right to Determine if Services are Medically Necessary: Benefits are available only for medically necessary services. The Company has the right to require information, including medical records, to make this decision. B. Insured/Provider Relationship: The choice of a provider is solely that of the Insured. C. The Company's Responsibility is Limited: Institutional Provider services are subject to the rules and regulations of the provider including rules about admissions, discharge and availability of services. The Company does not guarantee that admission or any specific type of room or kind of service will be available.