Common use of Adverse Decision Clause in Contracts

Adverse Decision. for the purposes of these Appeals procedures (and ERISA, as applicable), means a denial in whole or in part of a Pre-Service Claim or a Post-Service Claim and for which You are financially responsible or, for a Pre-Service Claim, for which You would be financially responsible, if You obtained the service. Adverse Decision, for the purposes of External Review procedures, is limited to the definition of Adverse Decision Eligible for External Review. Adverse Decision also means any retroactive cancellation of coverage other than for non-payment of premium.