Defendant’s Process for Denying Submitted Claim Forms Sample Clauses

Defendant’s Process for Denying Submitted Claim Forms. In the event Defendant denies any aspect of a Claim Form following a determination that certain disputed transactions were, in fact, authorized by the Settlement Class Member or otherwise not compensable under the EFTA. Defendant will identify those Claim Forms and provide a list to Class Counsel with an explanation and supporting information regarding the investigation that led to the denial(s). Within fourteen days upon receipt of the information, Defendant will confer with Class Counsel in good faith regarding any Claim Form denial Class Counsel seeks to challenge. Any Claim Form denial that is not challenged by Class Counsel is presumptively denied after fourteen (14) days of Defendant identifying the Claim Form and providing the supporting documents to Class Counsel. If Defendant maintains a denial decision, and following consultation with Class Counsel as to any challenged denials, the Settlement Administrator, within seven (7) days, shall provide written notice to the Settlement Class Member who submitted the form, by first class mail or electronic mail if available, with an electronic copy to Class Counsel and Defendant’s Counsel, stating: (a) that the claim was denied by Defendant in whole or in part ; (b) Defendant’s reason(s) for its determination; and (c) that the submitting person’s claim for actual damages has not been waived and that the statute of limitations for any claim of actual damages will remain tolled until entry of Final Judgment. A list of these individuals will be provided as an exhibit to the Final Approval Order.
Sample 1
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Related to Defendant’s Process for Denying Submitted Claim Forms

  • Claims Process (1) In order to seek payment from the Settlement Amount, a Class Member must submit a completed Claim Form to the Administrator, in accordance with the provisions of the Plan of Allocation, on or before the Claims Bar Deadline and any Class Member who fails to do so shall not share in any distribution made in accordance with the Plan of Allocation unless the relevant court orders otherwise as provided in section 18.4.

  • Complaints Procedure 18.1 If the Client has any cause for complaint in relation to the services provided by the Company, he should file a complaint as per the Company’s Complaint Handling policy which is available on the Company’s website.

  • Complaints Process The School shall establish and adhere to a process for resolving public complaints which shall include an opportunity for complainants to be heard. The final administrative appeal shall be heard by the School's Governing Board, except where the complaint pertains to a possible violation of any law or term under this Contract. The complaints process shall be readily accessible from the School’s website, as described in Section 11.4.1.

  • Retiree Benefits – Process for Payment Any bargaining unit nurse who retires and wishes to participate in the benefit plans as outlined in article 17.01(h) will provide advance payment of the benefits either through post-dated cheques provided on a yearly basis or through a preauthorized withdrawal process. It is understood that any transaction would be dated the first of each and every month. The Employer will notify the Union of the benefit costs to retired nurses in January of each year, and each time the benefit costs are renegotiated by the Employer.

  • Claims Submission We will submit your claims and assist you in any way we reasonably can to help get your claims paid. Your insurance company may need you to supply certain information directly. It is your responsibility to comply with their request. Please be aware that the balance of your claim is your responsibility whether or not your insurance company pays your claim. Your insurance benefit is a contract between you and your insurance company; we are not party to that contract.

  • Submitting False Claims; Monetary Penalties The AOC shall be entitled to remedy any false claims, as defined in California Government Code section 12650 et seq., made to the AOC by the Contractor or any Subcontractor under the standards set forth in Government Code section 12650 et seq. Any Contractor or Subcontractor who submits a false claim shall be liable to the AOC for three times the amount of damages that the AOC sustains because of the false claim. A Contractor or Subcontractor who submits a false claim shall also be liable to the AOC for (a) the costs, including attorney fees, of a civil action brought to recover any of those penalties or damages, and (b) a civil penalty of up to $10,000 for each false claim.

  • Appeals Process A. The Contractor’s appeal process shall, at a minimum:

  • Claims Review Population A description of the Population subject to the Claims Review.

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