Denied Claims. If a Workers' Compensation claim is denied, the employee's absence 10 from work due to illness or injury shall, to the extent not compensated as Workers' 11 Compensation time loss, be subject to the provisions of Article 9, Sick Leave.
Denied Claims. A. If a Workers' Compensation claim is denied, the employee's absence from work due to illness or injury shall, to the extent not compensated as Workers' Compensation time loss, be subject to the provisions of Article 9,
Denied Claims. 11 A. If a Worker's Compensation claim is denied, the employee's absence from 12 work due to illness or injury shall, to the extent not compensated as Workers’ 13 Compensation time loss, be subject to the provisions of Article 9, Sick Leave.
14 B. If a Worker's Compensation claim, which has been denied, is later held 15 compensable upon appeal, any time loss benefits shall be reimbursed by the employee 16 to the County and the employee's sick leave account credited with an equivalent number 17 of days.
18 C. If an employee's Workers' Compensation claim is under appeal, and he or 19 she is no longer entitled to medical/dental coverage under Article 11, Health and Welfare, 20 he or she will be entitled to continued coverage under federal COBRA law. The duration 21 of such coverage will be for six (6) months or the legally mandated period, whichever is 22 greater, provided that the employee continues to be eligible and pays the premiums as 23 required.
24 D. If a denied claim is later held compensable upon appeal, the employee 25 will be entitled to:
26 1. Reimbursement of any premiums paid to the County for 27 medical/dental benefits, and
28 2. Any supplemental benefits not paid in accordance with “Section IV” 29 of this Article.
Denied Claims. 11 A. If a workers' compensation claim is denied and later found to be 12 compensable or held compensable upon appeal and the employee has been utilizing 13 sick, vacation, or holiday leave, the employee will reimburse the County for any accrual 14 payments and the employee's sick, vacation, or holiday leave account will be credited 15 with an equivalent number of hours.
16 B. If an employee's workers' compensation claim is denied before the employee 17 returns to work the employee is entitled to request continued medical and dental 18 coverage at the employee’s expense, under COBRA regulations.
19 C. If a denied claim is later held compensable upon appeal, the employee will 20 be entitled to:
21 1. Reimbursement of any premiums paid to the County for medical/dental 22 benefits, and
23 2. Any other supplemental benefits .
Denied Claims. Any Settlement Class Member whose claim is denied, in whole or in part, either by the Claims Administrator or Defendant, will receive from the Claims Administrator by first-class mail a written explanation stating the reason(s) for the denial. The Claims Administrator’s letter will also inform Settlement Class Members that they may appeal from a denial if they have a basis to do so and have timely submitted all required documentation in support of an eligible claim by submitting an appeal in writing to the Claims Administrator within thirty (30) days of mailing of the notice of denial.
Denied Claims. 14 A. If an Oregon workers' compensation claim is denied and later found to be 15 compensable or held compensable upon appeal and the employee has been utilizing sick, 16 vacation, or holiday leave, the employee will reimburse the County for any accrual 17 payments and the employee's sick, vacation, or holiday leave account will be credited 18 with an equivalent number of hours.
19 B. If an employee's Oregon workers' compensation claim is denied before the 20 employee returns to work, the employee is entitled to request continued medical and 21 dental coverage at the employee’s expense, under COBRA regulations.
22 C. If a denied claim is later held compensable upon appeal, the employee will 23 be entitled to:
24 1. Reimbursement of any premiums paid to the County for 25 medical/dental benefits, and
26 2. Any supplemental benefits that have not already been paid in 27 accordance with “Section III.” of this Article.
Denied Claims. In the event the Settlement Administrator denies a claimant’s Claim, the claimant shall have twenty-one (21) days from date denial or partial denial of a Claim from the Settlement Administrator to dispute such determination in writing and request an appeal. If a claimant disputes a determination in writing and requests an appeal, the Settlement Administrator shall review the Claim, provide a copy of the claimant’s dispute, Claim Form and any necessary additional information to Class Counsel and Defendant’s Counsel for their review, and make a final determination within ten (10) days without any further action.
Denied Claims. Nothing in this Agreement prohibits ATHP from seeking reimbursement from any other payer, including the Veteran (if consistent with ATHP’s policies) for Direct Case Services provided to a Veteran for which VA is not responsible due to the Veteran being ineligible for such service under VA benefit rules (i.e. services is not an “eligible service” as defined in this Agreement) or for any other reason, or for which VA denies payment for any reason.
Denied Claims. The HCA, DCYF and DSHS shall not pay any claims for services submitted more than 12 months after the calendar month in which the services were performed. HCA, within the Special Terms and Conditions of this Contract, may reduce the length of time following the provision of services in which the Contractor must submit claims for payment.
Denied Claims. 14 A. If a Workers' Compensation claim is denied, the employee's absence 15 from work due to illness or injury shall, to the extent not compensated as Workers' 16 Compensation time loss, be subject to the provisions of Article 8 Sick Leave.
17 B. If a Workers' Compensation claim which has been denied is later held 18 compensable upon appeal, any time loss benefits shall be reimbursed to the employee 19 by the County and the employee's sick leave account credited with an equivalent 20 number of days.
21 C. If an employee's Workers' Compensation claim is under appeal, and he 22 or she is no longer entitled to medical/dental coverage under Article 10, Health and 23 Welfare, he or she will be entitled to continued coverage under federal COBRA law. 24 The duration of such coverage will be for the duration permitted by law, provided that 25 the employee continues to be eligible and pays the premiums as required.
26 D. If a denied claim is later held compensable upon appeal, the employee 27 will be entitled to:
28 1. Reimbursement of any premiums paid to the County for 29 medical/dental benefits, and
30 2. Any supplemental benefits not paid in accordance with the next 31 section.
