Appeal Decisions. We try to reach a decision on appeal cases within 6 – 8 weeks. If an appeal cannot be dealt with within this timescale, the complainant will be advised that the appeal may take longer than previously indicated. If the original decision on the case is upheld, the Board of Appeal will ensure that all relevant matters mentioned in the appeal are addressed in the appeal decision letter. If the original decision is reversed and the complaint is upheld, the Board of Appeal will include an apology in the appeal decision letter and an explanation for the change in outcome. If the Board of Appeal considers that further examination is needed, the appeal will be closed and a new case will be opened. The complainant will be informed of the decision to carry out a further re- examination of the complaint.
Appeal Decisions. If you file your appeal on time and follow any applicable required procedures, a new, full, and independent review of your claim will be made and the decision will not be deferred to the initial benefit decision. An appropriate fiduciary of the Plan will conduct the review and the decision will be based on all information used in the initial determination as well as any additional information submitted. If the appeal is decided at a meeting of the Board of Trustees, the Plan will notify you, in writing, of the decision on any appeal within five days. However, oral notice of a determination on your urgent care claims may be provided to you sooner; otherwise, the time frame for decisions will be as provided in the next section.
Appeal Decisions. 5.1 The Funder retains full discretion over whether it provides funding for any litigation in appeal of a decision made by a Court in any Proceeding. If the Funder does elect to fund an Appeal. the Funder will pay the Legal Costs and Disbursements in connection with the Appeal and will pay any Adverse Costs Order if the Appeal is unsuccessful. The costs of any Appeal will form part of the Project Costs.
