Compensability Sample Clauses

Compensability. 1. The initial compensability determination (accept claim, deny claim or delay acceptance pending the results of additional investigation) and the reasons for such a determination shall be made and documented in the file within 14 calendar days of the filing of the claim with the employer. In the event the claim is not received by the third party administrator or self-administered entity within 14 calendar days of the filing of the claim with the employer, the third party administrator or self-administered entity shall make the initial compensability determination within 7 calendar days of receipt of the claim.
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Compensability. Compensability of leave shall be according to RCW 28B.50.553.
Compensability. There is a need for finality in the litigation, and □ Defendants have admitted Plaintiff’s claims for compensation □ Defendants have reasonably denied Plaintiff’s claims for compensation □ Defendants have admitted in part, and reasonably denied in part, Plaintiff’s claims for compensation
Compensability. The claims adjuster will conduct a thorough investigation of the facts of the claim – including any necessary statements, on-site investigations, or other fact finding methods of substantiating compensability issues, including pursuit of personnel records, prior medical records, ISO, police reports, and court reports. These investigative steps will be documented in claim notes. • Within 10 days, the claims adjuster will complete full investigation, obtain initial medical report(s), determine compensability (officially accept or deny the claim), evaluate the adequacy of initial reserves, and evaluate the file to assure that all appropriate documentation has been entered. • Within 14 days, the adjuster will approve payment for accepted claims • In complex claim investigations where a decision just cannot be made by the 10th day, the State can actually allow up to 90 days for a decision to be made. In these special circumstances, the adjuster will discuss with Xxxxxxx Xxxxxx. APPROVALS Before accepting any of the following types of claims, the adjuster will first obtain approval from Xxxxxxx Xxxxxx with the State of TN: • Death claims; • Heart attack/hypertension claims (HHL Claims); • National Guard claims APPROVAL NOTICES • Send a notice of compensability approval to the claimant on every approved claim (LT, MO and WCEXP). • Send a copy of every compensability approval notice (via e-mail) to the following contacts from the State's group insurance division: o Xxxxxxx Xxxxxxx xxxxxxx.xxxxxxx@xx.xxx o Xxxxxx Xxxxxxx xxxxxx.xxxxxxx@xx.xxx o Xxxxxx Xxxxxx xxxxxx.xxxxxx@xx.xxx • Send a copy of every compensability approval notice to the employee's designated HR contact(s) via e-mail.
Compensability. Where compensability is disputed and the City is denying responsibility for the payment of medical treatment, the injured member is not required to obtain treatment by an authorized provider, pending the resolution of compensability.
Compensability. Within 14-days of assignment, a compensability determination should be noted on all indemnity claims to outline the rationale for claim acceptance or denial. In the event a claim decision must be delayed due to investigation, further investigative action steps should be outline in the claim file notes. The range of acceptable performance is 90% or above. Action Plan The contactor shall document an initial action plan within 30 days of assignment for all indemnity claims. Updated action plans shall be completed thereafter at 60 and 90 days from the assignment date. After 90 days from assignment an action plan shall be completed at a minimum of every 90 days. The action plan shall include any information that relates to the direction of the claim as well as further work to be done and target date for completion of said work. The range of acceptable performance is 90% or above. Supervisor Review The Contractor shall document initial supervisor review in the claim file notes within 30 days of assignment of the claim. Subsequent supervisor reviews shall be documented every 90 days until file closure. Supervisor reviews shall include information that relates to the direction of the claim and further work to be done. The range of acceptable performance is 90% or above. Indemnity Payments The Contractor shall issue all undisputed indemnity payments in a timely manner. Timeliness is determined according to statutory limits. The range of acceptable performance is 90% or above.
Compensability 
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Related to Compensability

  • Employees with a Work-related Injury/Disability An employee who was off the State payroll due to a work-related injury or a work-related disability may continue to participate in the Group Insurance Program as long as such an employee receives workers' compensation payments or while the workers' compensation claim is pending.

  • Portability of Service An employee hired by the Hospital with recent and related experience may claim consideration for such experience at the time of hiring on a form to be supplied by the Hospital. Any such claim shall be accompanied by verification of previous related experience. The Hospital shall then evaluate such experience during the probationary period following hiring. Where in the opinion of the Hospital such experience is determined to be relevant, the employee shall be slotted in that step of the wage progression consistent with one (1) year's service for every one (1) year of related experience in the classification upon completion of the employee's probationary period. It is understood and agreed that the foregoing shall not constitute a violation of the wage schedule under the collective agreement."

  • Portability of Sick Leave 1. The employer will accept up to sixty (60) accumulated sick leave days from other school districts in British Columbia, for employees hired to or on exchange in the district.

  • Expropriation and Compensation 1. Neither Contracting Party shall expropriate or nationalise investments in its Area of investors of the other Contracting Party or take any measure equivalent to expropriation or nationalisation (hereinafter referred to as "expropriation") except:

  • Extended Health Benefits (i) The Employer, by means of a policy issued by the insurance company, provides extended health benefits to all eligible faculty members. The monthly premium for this benefit is assumed totally by the Employer for each eligible faculty member, spouse/common-law spouse and his/her dependants. Plan benefits will be paid in accordance with the schedule of benefits listed in the plan and will be subject to the limitations specified in the plan including eligibility requirements.

  • Preventive Care This plan covers preventive care as described below. “

  • Injury Compensation Employees covered by this Agreement shall be covered by Subchapter I of Chapter 81 of Title 5, and any amendments thereto, relating to compensation for work injuries. The Employer will promulgate appropriate regulations which comply with applicable regulations of the Office of Workers’ Compensation Programs and any amendments thereto.

  • REFUND OF UNEARNED COMPENSATION The Party of the Second Part agrees to refund the Party of the First Part any compensation received for which no services were rendered. TERMINATION: This contract may be terminated by either party pursuant to law. OTHER CONDITIONS: Any subsequent contracts shall supersede the provisions of this contract. In accordance with the Fort Xxxxx Public Schools drug and alcohol policy, I agree to consent to drug and/or alcohol tests immediately following any accident involving school vehicles and/or equipment. I authorize the release of any test results to the Fort Xxxxx Public Schools. Given this, the 5TH DAY OF JUNE, 2018 BY: BY: XXXXXX X XXXX Board President Xxxxx XxXxxxxx PARTIES: The Fort Xxxxx School District 100, Party of the First Part, and XXXXXXX X XXXXX Party of the Second Part, agree as follows:

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