Examples of Claims Review Committee in a sentence
Any question of interpretation, construction, application or enforcement of the terms of the Plan and this SPD, and all determinations on benefit claims and appeals, are subject to the discretion of the Board of Trustees and/or its Claims Review Committee, whose determinations are final and binding.
Wherever the discretion of the Fund is noted in this Section, it refers to the discretion of the Fund personnel and the Claims Review Committee of the Board of Trustees.
If you have presented a claim for benefits under this SPD, you may file a request for review of its disposition or adverse benefit determination by appealing to the Claims Review Committee of the Board of Trustees of the UFCW National Health and Welfare Fund in writing, within 180 days after receiving written notice of the Fund's action.
At any time, the Claims Review Committee may refer a request for review to the Board of Trustees of the Fund.
You will be notified, in writing, of the decision of the Claims Review Committee within 60 days of the date your request for review is received, unless there are special circumstances, in which case you will be so notified and then notified of the decision within 120 days.
The decision of the Claims Review Committee on a request for review will be final and binding if not timely appealed.
In deciding any appeal based in whole or in part on a medical judgment, the Claims Review Committee or Board of Trustees shall consult with a health care professional who has appropriate training and experience in the field of medicine involved in the medical judgment and who was neither consulted in connection with the adverse benefit determination nor the subordinate of any such individual.
If the question or complaint is not resolved to the satisfaction of the complainant, the complainant may submit a written request to the Claims Review Committee, which will make a thorough investigation and respond to the complainant in a timely manner.
Any question of interpretation, construction, application or enforcement of the terms of the Plan and SPD, and all determinations on benefit claims and appeals, are subject to the discretion of the Board of Trustees and/or its Claims Review Committee, whose determinations are final and binding.
Such lawsuit is filed within one year from the date of the Claims Review Committee Decision or, if a timely appealed has been presented to the Board of Trustees, the Board of Trustees Decision or, where applicable, the date of the External Review decision.