Common use of Determination of Enhancements Clause in Contracts

Determination of Enhancements. 7.2.1.1 Claims for Enhancements will be evaluated by the Claims Processor based on their merits, the EBP Claim Form, Claim Package, EBP Claim Package, the contemporaneous Medical Records provided by Qualified Claimants and any other terms of this Agreement. With the exception of Enhancements claims for lost wages, non-contemporaneous documents (including but not limited to non- contemporaneous Medical Records) cannot be submitted in support of any claims for Enhancements, and will not be considered in the Claims Processor’s evaluation. 7.2.1.2 The Claims Processor may demand, at its sole discretion and at the Qualified Claimant’s expense, that the Qualified Claimant provides additional Medical Records necessary to properly evaluate a claim for Enhancements. The Claims Processor has the right to obtain from each Qualified Claimant authorizations for the release of Medical Records, to be obtained at the Qualified Claimant’s expense, if necessary, to evaluate his/her claim. 7.2.1.3 The initial determination of eligibility for, and the amount of, each Net QRS-Related Enhancements Benefit will be made by the Claims Processor pursuant to Sections 5.1 and 5.2 and based on the Enrollment Form, Claim Package, any Additional Claim Information, and the terms of this Agreement. Appeal rights relating to such determinations are set forth in Section 5.4. 7.2.1.4 The initial determination of eligibility for, and the amount of, each Net Enhancements Benefit will be made by the Claims Processor pursuant to Sections 5.1 and 5.2 and based on the EBP Claim Form, Claim Package, EBP Claim Package, any Additional Claim Information, and the terms of this Agreement. Appeal rights relating to such determinations are set forth in Section 5.4. 7.2.1.5 The categories, criteria, and amount of Enhancements (including QRS- Related Enhancements) are set forth in the EBP Award Schedule.

Determination of Enhancements. 7.2.1.1 6.2.1.1 Claims for Enhancements will be evaluated by the Claims Processor based on their merits, the EBP Claim Form, Claim Package, EBP Claim Package, the contemporaneous Medical Records provided by Qualified Claimants and any other terms of this Agreement. With the exception of Enhancements claims for lost wages, nonNon-contemporaneous documents (including but not limited to non- non-contemporaneous Medical Records) cannot be submitted in support of any claims for Enhancements, and will not be considered in the Claims Processor’s evaluation. 7.2.1.2 6.2.1.2 The Claims Processor may demand, at its sole discretion and at the Qualified Claimant’s expense, that the Qualified Claimant provides provide additional Medical Records necessary to properly evaluate a claim for Enhancements. The Claims Processor has the right to obtain from each Qualified Claimant authorizations for the release of Medical Records, to be obtained at the Qualified Claimant’s expense, if necessary, to evaluate his/her claim. 7.2.1.3 6.2.1.3 The initial determination of eligibility for, and the amount of, each Net QRS-Related Enhancements Benefit will be made by the Claims Processor pursuant to Sections 5.1 4.1 and 5.2 4.2 and based on the Enrollment Form, EBP Claim Package, any Additional Claim Information, and the terms of this Agreement. Appeal rights relating to such determinations are set forth in Section 5.44.4. 7.2.1.4 6.2.1.4 The initial determination of eligibility for, and the amount of, each Net Enhancements Benefit will be made by the Claims Processor pursuant to Sections 5.1 4.1 and 5.2 4.2 and based on the EBP Claim Form, Claim Package, EBP Claim Package, any Additional Claim Information, and the terms of this Agreement. Appeal rights relating to such determinations are set forth in Section 5.44.4. 7.2.1.5 6.2.1.5 The categories, criteria, and amount of Enhancements (including QRS- Related Enhancements) are set forth in the EBP Award Schedule.