Appeal of Denied Claims. You may appeal the claims official's denial of your claim in writing to an appeals official designated by the Company (which may be a person, committee, or other entity) for a full and fair appeal. You must appeal a denied claim within five days after your receipt of written notice denying your claim, or within 60 days after such written notice was due, if the written notice was not sent. In connection with the appeals proceeding, you (or your duly authorized representative) may review pertinent documents and may submit issues and comments in writing. You may only present evidence and theories during the appeal that you presented during the initial claims stage, except for information the claims official requested you to provide to perfect the claim. You will irrevocably waive any theories you do not in good faith pursue through the appeal stage, such as by failing to file a timely appeal request.
Appeal of Denied Claims. You may appeal the claims official's denial of your claim in writing to an appeals official designated by the Company (which may be a person, committee, or other entity) for a full and fair appeal. In connection with the appeals proceeding, you (or your duly authorized representative) may review pertinent documents and may submit issues and comments in writing.
Appeal of Denied Claims. In the event Medicare, Medicaid, or any other third-party payor denies any claim for Hospice Services for services provided to a Resident Patient pursuant to the terms of this Agreement, Hospice and Nursing Facility shall reasonably cooperate in the pursuit of any appeal of such denied claims initiated by either Party upon the written request of the other.
Appeal of Denied Claims. In the event Medicare, Medicaid, or any other third party payor denies any claim for Hospice Services for services provided to Patient pursuant to this Agreement, Hospice and SNF shall confer with one another and shall reasonably cooperate in the pursuit of any appeal of such denied claims initiated by either Party upon the request of the other.
Appeal of Denied Claims. The Claims Fiduciary shall, if requested by the claimant in accordance with procedures established by the Claims Fiduciary, afford such claimant a reasonable opportunity to a full and fair review thereof by the Claims Fiduciary in accordance with the requirements set forth in Section 503 of ERISA. The Claims Fiduciary shall provide a Covered Employee or Dependent, upon request and free of charge, with a copy of its appeals procedures. Upon enrollment in the Plan, the Company shall provide each Covered Employee with contact information that may be used to make such a request of the Claims Fiduciary.
Appeal of Denied Claims. Refer to the section entitled “Initial Claims Decisions and Claims Appeals Procedures” under Article V - Miscellaneous Provisions for information on appealing denied Claims.
Appeal of Denied Claims. If the Claimant’s claim is denied and he or she wants to submit a request for a review of the denied claim, the following rules apply:
Appeal of Denied Claims. If the Participant’s claim is denied and he or she wishes to submit a request for a review of the denied claim, the Participant or his or her authorized representative must follow the procedures described below:
(a) Upon receipt of the denied claim, the Participant (or his or her authorized representative) may file a request for review of the claim in writing with the Administrator. This request for review must be filed no later than sixty (60) days after the Participant has received written notification of the denial.
(b) The Participant has the right to submit in writing to the Administrator any comments, documents, records or other information relating to his or her claim for benefits.
(c) The Participant has the right to be provided with, upon request and free of charge, reasonable access to and copies of all pertinent documents, records and other information that is relevant to his or her claim for benefits.
(d) The review of the denied claim will take into account all comments, documents, records and other information that the Participant submitted relating to his or her claim, without regard to whether such information was submitted or considered in the initial denial of his or her claim.
Appeal of Denied Claims. If the Employee's claim is denied and the Employee wishes to submit a request for a review of the denied claim, the Employee or the Employee's authorized representative must follow the procedures described below:
(i) Upon receipt of the denied claim, the Employee (or the Employee's authorized representative) may file a request for review of the claim in writing with the Administrator. This request for review must be filed no later than 60 days after the Employee has received written notification of the denial.
(ii) The Employee has the right to submit in writing to the Administrator any comments, documents, records or other information relating to the Employee's claim for benefits.
(iii) The Employee has the right to be provided with, upon request and free of charge, reasonable access to and copies of all pertinent documents, records and other information that is relevant to the Employee's claim for benefits.
(iv) The review of the denied claim will take into account all comments, documents, records and other information that the Employee submitted relating to the Employee's claim, without regard to whether such information was submitted or considered in the initial denial of the Employee's claim.
