Appeals of Denied Claims Sample Clauses

Appeals of Denied Claims. In the event that WSP denies payment of claim(s) submitted by the Fire Agency under this Agreement, the Fire Agency may appeal the denial according to the Mobilization Plan. The process contained in the Mobilization Plan is the sole administrative recourse available to the Fire Agency for the appeal of denied claims.
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Appeals of Denied Claims. If a claim is denied, totally or partially, the Administrator will provide the Claimant with a written denial stating (i) the specific reasons for the denial, (ii) references to the pertinent Plan provisions upon which the denial is based, (iii) a description of any additional information the Claimant might be required to provide with an explanation of why it is needed, and (iv) an explanation of the Plan’s appeal procedure. The written denial will be sent to the Claimant within 60 days after receipt of the claim by the Administrator. The 60 days may be extended for up to another 30 days if special circumstances warrant an extension of time. If the Administrator needs an extension to process the claim, the Claimant will be notified in writing before the beginning of the extension period. The notice will include an explanation of the circumstances requiring the extension of time and the date by which the Administrator expects to render a decision on the claim. A Claimant may appeal the denial of a claim for Benefits by submitting a written request for a full and fair review to the Administrator. The Claimant may examine pertinent documents and submit pertinent issues and comments in writing; provided that neither the Employer nor the Administrator will be required by virtue of this provision to waive any privilege as to materials in their records or the records of their agents, including but not limited to the attorney-client privilege. The Claimant may have a representative throughout the appeals process who, if the Claimant chooses, may be a representative from the bargaining unit of which the Claimant is a member. The Claimant’s written request for a review must be submitted within 60 days of the written notice of denial of the claim. The full and fair review will be completed and a decision rendered by the Administrator within 60 days after receipt of the written request for review; provided that the time for rendering a decision may be extended upon written notice to the Claimant, if warranted by special circumstances, for up to 30 days from the date of the receipt of the written request for review. The Administrator’s decision will be in writing and will include specific reasons for the decision, with specific references to the Plan provisions on which the decision is based. The decision of the Administrator will be final and binding; provided, however, that this procedure is not intended to limit other remedies that may be available to the Claimant u...
Appeals of Denied Claims. Each Claimant shall have the opportunity to appeal the claims official’s denial of a claim in writing to an appeals official appointed by the Plan Administrator (which may be a person, committee, or other entity). A Claimant must appeal a denied claim within sixty (60) days after receipt of written notice of denial of the claim, or within sixty (60) days after it was due if the Claimant did not receive it by its due date. The Claimant shall have the opportunity to submit written comments, documents, records and other information relating to the Claimant’s claim. The Claimant (or the Claimant’s duly authorized representative) shall be provided upon request and free of charge, reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim. The appeals official shall take into account during its review all comments, documents, records and other information submitted by the Claimant relating to the claim, without regard to whether such information was submitted or considered in the initial benefits review. Any claims that the Claimant does not pursue in good faith through the appeals stage, such as by failing to file a timely appeal request, shall be treated as having been irrevocably waived.
Appeals of Denied Claims. The Executive shall have the opportunity to appeal the claims official’s denial of a claim in writing to an appeals official appointed by the Plan Administrator (which may be a person, committee, or other entity). The Executive must appeal a denied claim within sixty (60) days after receipt of written notice of denial of the claim, or within sixty (60) days after it was due if the Executive did not receive it by its due date. The Executive shall have the opportunity to submit written comments, documents, records and other information relating to the Executive’s claim. The Executive (or the Executive’s duly authorized representative) shall be provided upon request and free of charge, reasonable access to, and copies of, all documents, records and other information relevant to the Executive’s claim. The appeals official shall take into account during its review all comments, documents, records and other information submitted by the Executive relating to the claim, without regard to whether such information was submitted or considered in the initial benefits review. Any claims that the Executive does not pursue in good faith through the appeals stage, such as by failing to file a timely appeal request, shall be treated as having been irrevocably waived. Appendix A-1

Related to Appeals of Denied Claims

  • Released Claims In consideration of these additional benefits, you, on behalf of your heirs, spouse and assigns, hereby completely release and forever discharge Ikanos, its past and present affiliates, agents, officers, directors, shareholders, employees, attorneys, insurers, successors and assigns (collectively referred to as the “Company”) from any and all claims, of any and every kind, nature and character, known or unknown, foreseen or unforeseen, based on any act or omission occurring prior to the date of you signing this Release Agreement, including but not limited to any claims arising out of your offer of employment, your employment or termination of your employment with the Company or your right to purchase, or actual purchase of shares of stock of the Company (including, but not limited to, all rights related to or associated with stock options and restricted stock units), including, without limitation, any claims for fraud, misrepresentation, breach of fiduciary duty, breach of duty under applicable state corporate law, and securities fraud under any state or federal law. The matters released include, but are not limited to, any claims under federal, state or local laws, including claims arising under the Age Discrimination in Employment Act of 1967 (“ADEA”) as amended by, including but not limited to, the Older Workers’ Benefit Protection Act (“OWBPA”) and any common law tort contract or statutory claims, and any claims for attorneys’ fees and costs. You understand and agree that this Release Agreement extinguishes all claims, whether known or unknown, foreseen or unforeseen, except for those claims expressly described below. You expressly waive any rights or benefits under Section 1542 of the California Civil Code, or any equivalent statute. California Civil Code Section 1542 provides as follows: “A GENERAL RELEASE DOES NOT EXTEND TO CLAIMS WHICH THE CREDITOR DOES NOT KNOW OR SUSPECT TO EXIST IN HIS FAVOR AT THE TIME OF EXECUTING THE RELEASE, WHICH IF KNOWN BY HIM MUST HAVE MATERIALLY AFFECTED HIS SETTLEMENT WITH THE DEBTOR.” You fully understand that, if any fact with respect to any matter covered by this Release Agreement is found hereafter to be other than or different from the facts now believed by you to be true, you expressly accept and assume that this Release Agreement shall be and remain effective, notwithstanding such difference in the facts.

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