Claim Review. If the Executive or the Executive's Beneficiary (a "Claimant") believes that he or she has been denied all or a portion of a benefit under this Agreement, he or she may file a written claim for benefits with the Company. The Company shall review the claim and notify the Claimant of the Company's decision within 60 days of receipt of such claim, unless the Claimant receives written notice prior to the end of the 60 day period stating that special circumstances require an extension of the time for decision. The Company's decision shall be in writing, sent by mail to the Claimant's last known address, and if a denial of the claim, must contain the specific reasons for the denial, reference to pertinent provisions of this Agreement on which the denial is based, a designation of any additional material necessary to perfect the claim, and an explanation of the claim review procedure.
Claim Review. If the Settlement Administrator suspects fraud or misleading conduct with respect to any Claim, the Settlement Administrator will immediately bring the Claim to the attention of Co-Lead Class Counsel and Counsel for NIBCO, who shall meet and confer with the Settlement Administrator concerning the Claim, and who reserve the right to bring the Claim to the attention of the Court.
Claim Review. If the Settlement Administrator suspects fraud or misleading conduct with respect to any Claim, the Settlement Administrator will immediately bring the Claim to the attention of Class Counsel and Counsel for Generac, who shall meet and confer with the Settlement Administrator concerning the Claim, and who reserve the right to bring the Claim to the attention of the Court or the appropriate authorities.
Claim Review. Upon receipt of any written claim for benefits, the Plan Committee shall be notified and shall give due consideration to the claim presented. If the claim is denied to any extent by the Plan Committee, the Plan Committee shall furnish the claimant with a written notice setting forth (in a manner calculated to be understood by the claimant):
Claim Review. A claim review may be done only when a PARTICIPANT requests a review of denied BENEFITS. When a claim review has been completed, and the decision is to uphold the denial of BENEFITS, the PARTICIPANT shall receive written notification as to the specific reason(s) for the continued denial of BENEFITS and of his/her right to file a grievance. A CASE REVIEW OR CLAIM REVIEW MAY NOT BE SUBSTITUTED FOR A GRIEVANCE. GRIEVANCES REGARDING NONCOVERED SERVICES OR SERVICES EXCLUDED FROM COVERAGE BY THE HEALTH BENEFIT PLAN SHALL BE HANDLED LIKE ANY OTHER GRIEVANCE. GRIEVANCES SUBMITTED BY A HEALTH CARE PROVIDER CANNOT BE REFERRED TO THE CLAIM APPEAL UNIT.
Claim Review. Claims will be reviewed and paid in accordance with Health Plan’s policies and procedures which are based on Health Plan’s experience and industry standard billing and payment rules, including, but not limited to, the Uniform Billing (“UB”) manual and editor, Current Procedural Terminology (“CPT”) and Healthcare Common Procedure Coding System (“HCPCS”), federal and state/commonwealth billing and payment rules, National Correct Coding Initiatives (“NCCI”) Edits, and Federal Drug Administration (“FDA”) definitions and determinations of designated implantable devices and implantable orthopedic devices. Furthermore, Provider acknowledges Health Plan’s right to conduct Medical Necessity reviews and apply clinical practice standards to determine appropriate payment. Payment may exclude certain items not billed in accordance with Health Plan’s policies and procedures or that do not meet Medical Necessity criteria. This section will survive any termination.
Claim Review. The Claims Administrator shall review and evaluate each Claim Form, including any Valid Proof of Purchase submitted therewith, for validity, timeliness, and completeness. Failure to provide all information requested on the Claim Form will not result in immediate denial or nonpayment of a Claim. Instead, the Claims Administrator will take reasonable and customary steps to notify the Claimant of the Claim deficiency, including but not limited to, written e-mail notification when possible, requesting the additional information necessary to demonstrate eligibility. If, in the determination of the Claims Administrator, the Claimant completes a timely but incomplete Claim Form (e.g., the Claim Form is not signed; there is no Valid Proof of Purchase when it appears the Claimant intended to provide one or more Valid Proofs of Purchase; or there is an inadequate Valid Proof of Purchase), the Claims Administrator will take such steps to notify the Claimants of the Claim deficiency within thirty (30) days after the Claim Deadline or within thirty (30) days of receipt of a timely postmarked response, whichever is later. To cure the deficiency, the Claim Form deficiency response must be submitted via the online claim portal or postmarked within thirty (30) days after the mailing date of the notice of defect by the Claims Administrator and must cure the core defect of the Claim or the Claim will be denied. If the Claimant cures the deficiencies identified by the Claims Administrator within the thirty (30) day period following notice by the Claims Administrator, and the Claims Administrator thereafter determines that the Claimant’s Claim is complete and valid, the Claims Administrator shall include the Claimant in the Class Member Payment List. Claim Forms shall be reviewed and evaluated for deficiencies in the order in which they are received, to the extent practicable. Class Counsel and Defense Counsel shall have the right to review the Claim files of the Claims Administrator at any time. The Claims Administrator shall have the right to confer with Class Counsel and Defense Counsel with respect to any Claim.
Claim Review. If the Claim Administrator issues a Claim Denial, and if the Settlement Class Member who submitted that Claim submits a Claim Review Request Form (or other information, documents, data and materials sufficient to constitute all of the information required for a complete Claim Review Request Form) to the Claim Administrator within thirty
Claim Review. Upon receiving a statement of claim, and with the advice and assistance of the Architect- Engineer as appropriate, the Owner may review the statement of claim submitted by Contractor. In conducting this review, the Architect- Engineer or other person designated by the Owner shall have the right to require Contractor to submit such additional or supporting documents, data and other information as the Owner may require, and the failure to submit such additional documents, data or other information within thirty (30) days following w1itten request shall be deemed a waiver of the claim. Contractor agrees that it will produce any documents requested that would otherwise be producible in a civil action under O.C.G.A. § 9-11-34. Upon completion of such review, to take place within such time as the Owner may designate following receipt of the additional documents, data or other information as may have been required by the Owner in consultation with the Architect- Engineer may issue a written detem1ination, and if it deems appropriate accept such parts of the claim as are found in good faith to be proper. If Contractor agrees, a Change Order shall be issued to amend the Agreement Price, the time for completion or either of them as may be found proper. If Contractor disputes the determination made by the Owner, Contractor as a condition precedent to any further action to resolve such dispute must notify the Owner and the Architect-Engineer in writing within ten (10) days following receipt of the decision of the factual basis of such dispute and permit the Owner fifteen (15) additional days to reconsider and, if it deems it appropriate, issue a modified decision.
Claim Review. All claims submitted for reimbursement pursuant to Section III.E. (Reimbursement for Out of Pocket Expenses) will be reviewed and accepted within thirty (30) days of receipt by the Claims Administrator, which will be responsible for ensuring that all information required under this Settlement Agreement has been submitted by the Settlement Class Member, including: (1) the VIN number associated with the claim matches the Settlement Class Member’s Vehicle’s VIN number (as provided by HMA to the Claims Administrator); (2) that the Settlement Class Member has not received any payments or refunds from HMA or an authorized Hyundai Dealer in connection with any complaints about the Smart Truck, that are equal to the amount of the claim for reimbursement submitted, and can be documented as such by HMA; and (3) that the claim for reimbursement is for an item or service that is covered under this Settlement Agreement.
