Appeal of a Denial Sample Clauses

Appeal of a Denial. If a request for disability leave benefits is denied, the employee shall be informed of the denial in writing. The employee may then file, in writing and within thirty (30) days of the notice of the denial, a request for an appeal of the denial with the Director of Administrative Services or his/her designee. Additional information regarding the employee's claim may be submitted with the employee's grievance and such information will be considered during the appeal. Where a medical question is at issue, the Director shall upon receiving a written request for an appeal, obtain a medical opinion from an independent third party who shall be mutually agreed to by the employee's physician and the Director. The selection of a third party shall be made within fifteen (15) days of the appeal, unless an extension is agreed to by the parties. The third party selected shall render a medical opinion within thirty (30) days of the selection. If the appeal to the Director results in denial of the disability leave benefits, the employee shall be informed of the denial in writing. The employee may then file, within thirty (30) days of the notice of the denial, a grievance in accordance with Article 20 of this Agreement. The grievance must be filed at Step 3 of the Grievance Procedure.
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Appeal of a Denial. If a request for disability leave benefits is denied, the employee shall be informed of the denial in writing. The employee may then file, in writing and within thirty (30) days of the original notice of the denial, a request for an appeal of the denial with the Director of DAS or designee. Information regarding the denial of the employee's application may be submitted with the employee's request for appeal and such information will be considered during the appeal process. If an appeal is not filed within thirty (30) days of the original notification of the denial, the Director of DAS or designee shall enter the determination as a final decision. Where a medical question is at issue, the Director of DAS or designee shall upon receiving a written request for an appeal, obtain a medical opinion from an independent third party who shall be mutually agreed to by the employee's physician and the Director of DAS. The selection of the third party shall be made within fifteen (15) days of the appeal request unless an extension is agreed to by the parties. The third party selected shall render a medical opinion within thirty (30) days of the selection and the decision of the third party shall be binding. Where a medical question is not at issue, the Director of DAS or designee will schedule a hearing pursuant to Chapter 119 of the Revised Code. If the appeal to the Director of DAS results in denial of the disability leave benefits, the employee shall be informed of the denial in writing.
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Related to Appeal of a Denial

  • Appeal of Discipline Permanent unit members who are deprived of salary or other loss in compensation or property rights as a result of the imposed discipline may appeal the disciplinary decision under Article XXI, Section 21.3.5, Arbitration, of the Grievance Procedure. Nothing herein shall prevent the parties from mutually agreeing to utilize Step IV, Mediation, of Article XXI, prior to Step V, Arbitration.

  • Denial of Application The employee may grieve a denial by the Employer of a requested floating holiday. The grievance shall be filed in accordance with the grievance procedure in the Agreement.

  • Denial If NB denies the Applicant, NB shall furnish a written statement stating its reasons. The Applicant shall have the opportunity to discuss the decision with the Director of Social Services. The Applicant has the right to an administrative fair hearing. If NB denies an Applicant based in part on an indicated child abuse or maltreatment report, the Applicant has a right to a fair hearing regarding the report. The request must be made within 90 days of receiving the written denial notice. (See Disclosures, page 10.)

  • How to File an Appeal of a Prescription Drug Denial For denials of a prescription drug claim based on our determination that the service was not medically necessary or appropriate, or that the service was experimental or investigational, you may request an appeal without first submitting a request for reconsideration. You or your physician may file a written or verbal prescription drug appeal with our pharmacy benefits manager (PBM). The prescription drug appeal must be submitted to us within one hundred and eighty (180) calendar days of the initial determination letter. You will receive written notification of our determination within thirty (30) calendar days from the receipt of your appeal. How to File an Expedited Appeal Your appeal may require immediate action if a delay in treatment could seriously jeopardize your health or your ability to regain maximum function, or would cause you severe pain. To request an expedited appeal of a denial related to services that have not yet been rendered (a preauthorization review) or for on-going services (a concurrent review), you or your healthcare provider should call: • our Grievance and Appeals Unit; or • our pharmacy benefits manager for a prescription drug appeal. Please see Section 9 for contact information. You will be notified of our decision no later than seventy-two (72) hours after our receipt of the request. You may not request an expedited review of covered healthcare services already received.

  • Denial of Grievance Failure by the School Board or its representative to issue a decision within the time periods provided herein shall constitute a denial of the grievance and the employee may appeal it to the next level.

  • Appeal of Award Within thirty (30) days of a final award by the single arbitrator, you or we may appeal the award for reconsideration by a three-arbitrator panel. If you or we appeal, the other party may cross- appeal within thirty (30) days afler notice of the appeal. The panel will reconsider all aspects of the initial award that are appealed, including related findings of fact.

  • Withdrawal of Grievance A grievance may be withdrawn at any level without establishing a precedent.

  • Appeal Rights Any dispute concerning the occurrence or amount of the overpayment will be resolved through the grievance procedure in Article 31 Grievance Procedure of this Agreement.

  • APPEAL ACTIONS Appeal of TMA actions under this agreement, to the extent they are allowable, will be pursuant to 32 CFR 199.10.

  • Approval of Claim When an employee is granted sick leave with pay and Workers’ Compensation leave is subsequently approved for the same period it shall be considered for the purpose of the record of sick leave credits that the employee was not granted sick leave with pay.

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