Common use of CLAIMS APPEALS Clause in Contracts

CLAIMS APPEALS. In the event of a disagreement between the insured and the insurer regarding this insurance policy and/or its conditions, before beginning any arbitration or legal proceeding, the insured shall request a review of the matter by the insurer’s appeals committee. In order to begin such review, the insured must submit a written request to the appeals committee. This request shall include copies of all relevant information sought to be considered, as well as an explanation of the decision that should be reviewed and why. The request shall be sent to the attention of the insurer’s appeals coordinator, c/o USA Medical Services. Upon submission of a request for review, the appeals committee will determine whether any further information and/ or documentation is needed and act to timely obtain it. The appeals committee will notify the insured of its decision and the underlying rationale within thirty (30) days.

CLAIMS APPEALS. In the event of a disagreement between the insured and the insurer regarding this insurance policy and/or its conditions, before beginning any arbitration or legal proceeding, the insured shall request a review of the matter by the insurer’s appeals committee. In order to begin such review, the insured must submit a written request to the appeals committee. This request shall include copies of all relevant information sought to be considered, as well as an explanation of the decision that should be reviewed and why. The request shall be sent to the attention of the insurer’s appeals coordinator, c/o USA Medical Services. Upon submission of a request for review, the appeals committee will determine whether any further information and/ or and/or documentation is needed and act to timely obtain it. The appeals committee will notify the insured of its decision and the underlying rationale within thirty (30) days.