Appeal Rights Any dispute concerning the occurrence or amount of the overpayment will be resolved through the grievance procedure in Article 31 Grievance Procedure of this Agreement.
WHAT WE EXCLUDE In addition to the exclusions appearing in the section "Which general exclusions apply to all of our covers?", we do not cover interruptions following: • cosmetic treatment, health cure, voluntary termination of pregnancy, in vitro fertilisation and its consequences; • depressive, mental or psychological illness without hospitalisation of less than three days; • epidemics or pandemics. WHAT WE EXCLUDE Apart from the exclusions appearing in the section “Which general exclusions apply to all our covers?", we cannot intervene or compensate if the immobilisation is due to: • running out of fuel or using the wrong fuel; • puncture; • losing, mislaying, theft or breakage of keys other than breakage of the key in the vehicle's steering anti-theft system; • repeated breakdowns of the same type caused by failure to repair the vehicle after our agents have initially intervened during the month preceding the event; • air conditioning problems and breakdowns; • unless stated otherwise in the policy, damage to bodywork that does not result in immobilisation of the vehicle; • consequences immobilising the vehicle for servicing; • Failures of alarm systems not fitted as standard. Our cover excludes reimbursements of: • fuel costs; • personal items and effects left in and/or on the vehicle; • customs and surveillance costs other than those previously agreed on by the assistance service; • goods and animals being carried; • vehicle repair and towing costs, spare parts; • all costs other than coverage of a replacement vehicle within the limits provided for in the Schedule of Cover. Immobilisation of the following vehicles is excluded from replacement vehicle cover: • motorcycles under 125 cc; • mopeds, scooters; • luggage trailers of a gross vehicle weight of more than 750 kg; • non-standard trailers and all trailers other than those intended for carrying luggage, as well as boat trailers and vehicle-carrying trailers; • registered motorised quadricycles driven without a licence; • vehicles intended to carry people for money such as driving-school cars, ambulances, taxis, hearses and hired vehicles; • vehicles designed to carry goods and animals. should comply with the following weight and dimensions: • Maximum weight: Less than 10 kilograms Maximum dimensions: the sum of the length, width and height of the parcel must not exceed 150 centimetres. Under no circumstances can the Insurer be held liable for: • delays attributable to the transport providers selected to deliver the forgotten item. the breakage, loss, damage or theft of the forgotten Item during transportation; • consequences resulting from the nature of the forgotten item; a refusal by national or international customs to authorise the shipment of the forgotten item.
How to File an Appeal of a Prescription Drug Denial For denials of a prescription drug claim based on our determination that the service was not medically necessary or appropriate, or that the service was experimental or investigational, you may request an appeal without first submitting a request for reconsideration. You or your physician may file a written or verbal prescription drug appeal with our pharmacy benefits manager (PBM). The prescription drug appeal must be submitted to us within one hundred and eighty (180) calendar days of the initial determination letter. You will receive written notification of our determination within thirty (30) calendar days from the receipt of your appeal. How to File an Expedited Appeal Your appeal may require immediate action if a delay in treatment could seriously jeopardize your health or your ability to regain maximum function, or would cause you severe pain. To request an expedited appeal of a denial related to services that have not yet been rendered (a preauthorization review) or for on-going services (a concurrent review), you or your healthcare provider should call: • our Grievance and Appeals Unit; or • our pharmacy benefits manager for a prescription drug appeal. Please see Section 9 for contact information. You will be notified of our decision no later than seventy-two (72) hours after our receipt of the request. You may not request an expedited review of covered healthcare services already received.
Background included 9.1.1 In Attachment 1, the Parties have identified and agreed on the Background for the Project and have also, where relevant, informed each other that Access to specific Background is subject to legal restrictions or limits. Anything not identified in Attachment 1 shall not be the object of Access Right obligations regarding Background.
Knowledge and Scholarship in Special Field Each certificated support person demonstrates a depth and breadth of knowledge of theory and content in the special field. He demonstrates an understanding of a knowledge about common school education and the educational milieu grades K12, and demonstrates the ability to integrate the area of specialty into the total school milieu, to wit:
Patent Rights The State and the U. S. Department of Transportation shall have the royalty free, nonexclusive and irrevocable right to use and to authorize others to use any patents developed by the Engineer under this contract.
Paid Claims without Supporting Documentation Any Paid Claim for which Practitioner cannot produce documentation shall be considered an error and the total reimbursement received by Practitioner for such Paid Claim shall be deemed an Overpayment. Replacement sampling for Paid Claims with missing documentation is not permitted.
Third Party Exclusion This Agreement is intended solely for the benefit of City and Contractor and is not intended to benefit, either directly or indirectly, any third party or member(s) of the public at large. No third party may sue for damages based on the terms or performance of this Agreement.
Product Claims You acknowledge that Company, not an App Distributor, is responsible for addressing any claims of yours or any third party relating to the Company application or your possession and/or use of the Company application, including, but not limited to: (i) product liability claims; (ii) any claim that the Company application fails to conform to any applicable legal or regulatory requirement; and (iii) claims arising under consumer protection or similar legislation. (5)
Breach excludes 11 1) Any unintentional acquisition, access, or use of PHI by a workforce member or 12 person acting under the authority of CONTRACTOR or COUNTY, if such acquisition, access, or use 13 was made in good faith and within the scope of authority and does not result in further use or disclosure 14 in a manner not permitted under the Privacy Rule.
