Common use of CLAIMS APPEALS Clause in Contracts

CLAIMS APPEALS. In the event of any disagreement between the Insured and the Insurer regarding this Insurance Policy and/or its provisions, the Insured, before commencing any arbitration or legal proceedings, shall request a review of the matter by the “Bupa Insurance Company Appeals Committee”. In order to begin such a 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 what decision should be reviewed and why. Said appeals shall be sent to the attention of the Bupa Insurance Company Appeals Coordinator, c/o USA Medical Services. Upon the 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 such. Within thirty (30) days thereafter, the Appeals Committee will notify the Insured of its decision and the underlying rationale.

CLAIMS APPEALS. In the event of any disagreement between the Insured and the Insurer regarding this Insurance Policy and/or its provisions, the Insured, before commencing any arbitration or legal proceedings, shall request a review of the matter by the “Bupa Insurance Company Appeals Committee”. In order to begin such a review, the Insured must submit a written request to the Appeals Committee. This request shall include copies of all relevant information infor- mation sought to be considered, as well as an explanation of what decision should be reviewed and why. Said appeals shall be sent to the attention of the Bupa Insurance Company Appeals Coordinator, c/o USA Medical Services. Upon the 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 such. Within thirty (30) days thereafter, the Appeals Committee will notify the Insured of its decision and the underlying rationale.