Common use of Allocation of Points Clause in Contracts

Allocation of Points. Approved Claimants will be assigned points at the sole discretion of the Claims Administrator, subject to the right of appeal provided herein. The Claims Administrator will assign points based on the totality of the information and resources available to it, using its best judgment and expertise to fairly and reasonably adjudicate claims. In the event that an Approved Claimant meets the criteria for both qualifying treatment(s) and qualifying surgery(s), the Approved Claimant shall receive the points allocated to both levels. In the event that an Approved Claimant received more than one BSC Transvaginal Mesh Device, the Approved Claimant shall receive the points allocated to each BSC Transvaginal Mesh Device, including any points allocated for qualifying treatment(s) and qualifying surgery(s) attributable to each BSC Transvaginal Mesh Device. 1 Device only (does not qualify in any other category). *Points allocated for Level 1 claims shall be capped at a maximum for $4,000.00 for each device implanted. 4 points Qualifying Treatment(s) (maximum qualifying treatment points = 9) A. Pain medications for treatment of pelvic pain (commencing at least 90 days after implantation of BSC Transvaginal Mesh Device, and with continuous use for a period of at least two months); B. Physical therapy of pelvic floor and/or vaginal area (commencing at least 90 days after implantation of BSC Transvaginal Mesh Device, and involving at least 4 sessions over a 60 day period); C. Anesthetic block (e.g. epidural, spinal) for treatment of pain in or originating from the pelvic area; D. Trigger point injection, local nerve block, or nerve ablation in the pelvic area; E. Botox injection(s) into the pelvic muscles; F. Revision and/or trim of BSC Transvaginal Mesh Device(s), which is performed using topical anesthesia or local anesthesia; G. Drainage of sinus tract or abscess occurring within the vicinity of the site of implantation or the insertion tract of BSC Transvaginal Mesh Device(s), and which is 6 points 1 Attribution of a condition or symptom to a complication from implantation of mesh and/or the treatment thereof may be established by a temporal relationship between the implantation of mesh, the condition and/or symptom, and/or the treatment. performed at least 30 days after the implantation of a BSC Transvaginal Mesh Device; H. 3 or more bacterial infections of the vagina or urinary tract treated with antibiotics at least 30 days after the implantation of a BSC Transvaginal Mesh Device; or I. Such other non-surgical mesh-related treatment(s) and/or new-onset mesh-related condition(s) as may be appropriate to consider under Level 2, including extraordinary injuries such as fistula, and organ (i.e. bladder or bowel) perforation. 2b Two or more qualifying treatments Approved Claimants shall receive 1 point for each additional qualifying treatment up to a maximum of 3 points. Add 1-3 points to 2a Qualifying Surgery(s) (maximum qualifying surgery points = 24) 3a One qualifying surgery, defined as a surgical procedure performed under general anesthesia2 or regional anesthesia3 to: A. Remove all or a portion of BSC Transvaginal Mesh Device; B. Release the arms of a BSC Transvaginal Mesh Device; C. Excise or lyse scar tissue or scar bands at site of implant of a BSC Transvaginal Mesh Device; or D. Explore the cause of a condition or symptom suspected by the treating medical provider(s) in the contemporaneous medical records to be caused by the implantation of a BSC Transvaginal Mesh Device, which is performed via an open or laparoscopic approach, and for which the operative records do not reflect that another cause of the condition or symptom (e.g., ovarian cyst, endometriosis) was determined as the cause during surgery. For clarification, where the operative records reflect that another cause of the condition or symptoms (e.g., ovarian cysts, endometriosis) was determined as a cause during surgery, 10 points

Allocation of Points. Approved Claimants will be assigned points at the sole discretion of the Claims Administrator, subject to the right of appeal provided herein. The Claims Administrator will assign points based on the totality of the information and resources available to it, using its best judgment and expertise to fairly and reasonably adjudicate claims. In the event that an Approved Claimant meets the criteria for both qualifying treatment(s) and qualifying surgery(s), the Approved Claimant shall receive the points allocated to both levels. In the event that an Approved Claimant received more than one BSC Transvaginal Mesh Device, the Approved Claimant shall receive the points allocated to each BSC Transvaginal Mesh Device, including any points allocated for qualifying treatment(s) and qualifying surgery(s) attributable to each BSC Transvaginal Mesh Device. 1 Device only (does not qualify in any other category). *Points allocated for Level 1 claims shall be capped at a maximum for $4,000.00 for each device implanted. 4 points Qualifying Treatment(s) (maximum qualifying treatment points = 9) A. Pain medications for treatment of pelvic pain (commencing at least 90 days after implantation of BSC Transvaginal Mesh Device, and with continuous use for a period of at least two months); B. Physical therapy of pelvic floor and/or vaginal area (commencing at least 90 days after implantation of BSC Transvaginal Mesh Device, and involving at least 4 sessions over a 60 60-day period); C. Anesthetic block (e.g. epidural, spinal) for treatment of pain in or originating from the pelvic area; D. Trigger point injection, local nerve block, or nerve ablation in the pelvic area; E. Botox injection(s) into the pelvic muscles; F. Revision and/or trim of BSC Transvaginal Mesh Device(s), which is performed using topical anesthesia or local anesthesia; G. Drainage of sinus tract or abscess occurring within the vicinity of the site of implantation or the insertion tract of BSC Transvaginal Mesh Device(s), and which is 6 points 1 Attribution of a condition or symptom to a complication from implantation of mesh and/or the treatment thereof may be established by a temporal relationship between the implantation of mesh, the condition and/or symptom, and/or the treatment. performed at least 30 days after the implantation of a BSC Transvaginal Mesh Device; H. 3 or more bacterial infections of the vagina or urinary tract treated with antibiotics at least 30 days after the implantation of a BSC Transvaginal Mesh Device; or I. Such other non-surgical mesh-related treatment(s) and/or new-onset mesh-related condition(s) as may be appropriate to consider under Level 2, including extraordinary injuries such as fistula, and organ (i.e. bladder or bowel) perforation. 6 points 2b Two or more qualifying treatments Approved Claimants shall receive 1 point for each additional qualifying treatment up to a maximum of 3 points. Add 1-3 points to 2a Qualifying Surgery(s) (maximum qualifying surgery points = 24) 3a One qualifying surgery, defined as a surgical procedure performed under general anesthesia2 or regional anesthesia3 to: A. Remove all or a portion of BSC Transvaginal Mesh Device; B. Release the arms of a BSC Transvaginal Mesh Device; C. Excise or lyse scar tissue or scar bands at site of implant of a BSC Transvaginal Mesh Device; or D. Explore the cause 10 points 1 Attribution of a condition or symptom suspected to a complication from implantation of mesh and/or the treatment thereof may be established by the treating medical provider(s) in the contemporaneous medical records to be caused by a temporal relationship between the implantation of a BSC Transvaginal Mesh Devicemesh, which is performed via an open or laparoscopic approach, and for which the operative records do not reflect that another cause of the condition or symptom (e.g.and/or symptom, ovarian cyst, endometriosis) was determined as and/or the cause during surgery. For clarification, where the operative records reflect that another cause of the condition or symptoms (e.g., ovarian cysts, endometriosis) was determined as a cause during surgery, 10 pointstreatment.

Allocation of Points. Approved Claimants will be assigned points at the sole discretion of the Claims Administrator, subject to the right of appeal provided herein. The Claims Administrator will assign points based on the totality of the information and resources available to it, using its best judgment and expertise to fairly and reasonably adjudicate claims. In the event that an Approved Claimant meets the criteria for both qualifying treatment(s) and qualifying surgery(s), the Approved Claimant shall receive the points allocated to both levels, including Level 1 points. In the event that an Approved Claimant received more than one BSC Transvaginal AMS Women’s Pelvic Mesh Device, the Approved Claimant shall receive the points allocated to each BSC Transvaginal AMS Women’s Pelvic Mesh Device, including any points allocated for qualifying treatment(s) and qualifying surgery(s) attributable to each BSC Transvaginal AMS Women’s Pelvic Mesh Device. 1 Device only (does not qualify in any other category). ) *Points allocated for Level 1 claims shall be capped at a maximum for of $4,000.00 for each device implanted. 4 points Qualifying Treatment(s) (maximum qualifying treatment points = 9) A. Pain medications for treatment of pelvic pain (commencing at least 90 days after implantation of BSC Transvaginal AMS Women’s Pelvic Mesh Device, and with continuous use for a period of at least two months); B. Physical therapy of pelvic floor and/or vaginal area (commencing at least 90 days after implantation of BSC Transvaginal AMS Women’s Pelvic Mesh Device, and involving at least 4 sessions over a 60 day period); C. Anesthetic block (e.g. epidural, spinal) for treatment of pain in or originating from the pelvic area; D. Trigger point injection, local nerve block, or nerve ablation in the pelvic area; E. Botox injection(s) into the pelvic muscles; F. Revision and/or trim of BSC Transvaginal AMS Women’s Pelvic Mesh Device(s), which is performed using topical anesthesia or local anesthesia; G. Drainage of sinus tract or abscess occurring within the vicinity of the site of implantation or the insertion tract of BSC Transvaginal AMS Women’s Pelvic Mesh Device(s), and which is 6 points 1 Attribution of a condition or symptom to a complication from implantation of mesh and/or the treatment thereof may be established by a temporal relationship between the implantation of mesh, the condition and/or symptom, and/or the treatment. performed at least 30 days after the implantation of a BSC Transvaginal an AMS Women’s Pelvic Mesh Device; H. 3 or more bacterial infections of the vagina or urinary tract treated with antibiotics at least 30 days after the implantation of a BSC Transvaginal an AMS Women’s Pelvic Mesh Device; or I. Such other non-surgical mesh-related treatment(s) and/or new-onset mesh-related condition(s) as may be appropriate to consider under Level 2, including extraordinary injuries such as fistula, and organ (i.e. bladder or bowel) perforation. 2b Two or more qualifying treatments Add 1-3 points to 2a 1 Attribution of a condition or symptom to a complication from implantation of mesh and/or the treatment thereof may be established by a temporal relationship between the implantation of mesh, the condition and/or symptom, and/or the treatment. Approved Claimants shall receive 1 point for each additional qualifying treatment up to a maximum of 3 points. Add 1-3 points to 2a Qualifying Surgery(s) (maximum qualifying surgery points = 24) 3a One qualifying surgery, defined as a surgical procedure performed under general anesthesia2 or regional anesthesia3 to: A. Remove all or a portion of BSC Transvaginal AMS Women’s Pelvic Mesh Device; B. Release the arms of a BSC Transvaginal an AMS Women’s Pelvic Mesh Device; C. Excise or lyse scar tissue or scar bands at site of implant of a BSC Transvaginal an AMS Women’s Pelvic Mesh Device; or D. Explore the cause of a condition or symptom suspected by the treating medical provider(s) in the contemporaneous medical records to be caused by the implantation of a BSC Transvaginal an AMS Women’s Pelvic Mesh Device, which is performed via an open or laparoscopic approach, and for which the operative records do not reflect that another cause of the condition or symptom (e.g., ovarian cyst, endometriosis) was determined as the cause during surgery. For clarification, where the operative records reflect that another cause of the condition or symptoms (e.g., ovarian cysts, endometriosis) was determined as a cause during surgery, and in addition reflect a concomitant findings that an AMS Women’s Pelvic Mesh Device was also a cause of the condition or symptom, such surgical procedure constitutes a qualifying surgery4. For clarification, a diagnostic cystoscopy without further surgical intervention is not included in such procedures. *In the event that an eligible claimant is implanted with both an AMS Women’s Pelvic Mesh Device(s) and one or more non-AMS mesh product(s) and during any qualifying surgery it is unclear which mesh product is revised or removed, or the cause of the 10 pointspoints 2 Absence of sensation and consciousness as induced by various anesthetic medications given by inhalation or IV Components of general anesthesia are analgesia, amnesia, muscle relaxation, control of xxxxx xxxxx, and unconsciousness. 3 Anesthesia provided by injecting an anesthetic to block a particular group of sensory nerve fibres (e.g. spinal, epidural, or block).