Filing Appeals. 7.1 Each German company shall, upon the completion of its processing of the claimant’s claim send to the claimant;
7.1.1 the determination regarding the claimant’s entitlement to the claimed insurance policy;
7.1.2 all documents relevant to the claim and to the company’s decision;
7.1.3 notice that an appeal against the determination is possible and on the time within which an appeal shall be filed;
7.1.4 an Appeal Form (Annex G) should the claimant want to appeal against the German company determination; and
7.1.5 a copy of these Guidelines.
7.2 A claimant wishing to file an appeal shall sign the Appeals Form and submit it by post to the Panel. Together with the form the claimant shall file the following:
7.2.1 a written statement of the grounds and reasons for making the appeal; and
7.2.2 any information or evidence supporting the appeal not already submitted to the claims process.
7.3 Any new information or evidence shall be forwarded to the German company and the GDV. In light of the new information or evidence the German company has the opportunity to make an offer to the claimant.
7.4 The appeal shall not be processed by the Panel, Panel Member or Arbiter before 30 working days have expired from the date the German company received the new evidence or information.
Filing Appeals. DocuSign Envelope ID: F73EF454-508D-44AC-ABD8-2A528194331A
(i) DVHA must allow beneficiaries to file appeals. DVHA must also allow providers, or authorized representatives, acting on behalf of the beneficiary and with the beneficiary's written consent, to request an appeal. XXXX must consider the beneficiary, his/her representative, or the legal representative of a deceased beneficiary’s estate as parties to an appeal.
(ii) Appeals may be filed within 60 calendar days from the date on the adverse benefit determination notice.
(iii) Beneficiaries, or their providers or authorized representatives, may file appeals orally or in writing for any DVHA adverse benefit determination. Oral inquiries to an internal appeal of an adverse benefit determination must be treated as appeals to establish the earliest possible filing date.
(iv) DVHA must provide each beneficiary seeking an appeal a reasonable opportunity, in person and in writing, to present evidence and testimony and make legal and factual arguments.
(v) DVHA must provide each beneficiary and his or her representative with the beneficiary's case file (including medical records, other documents and records, and any new or additional evidence considered, relied upon, or generated by DVHA (or at the direction of DVHA)) in connection with the appeal of an adverse benefit determination. DVHA must provide the case file free of charge and sufficiently in advance of the resolution timeframe for standard and expedited appeal resolutions.
Filing Appeals. You or your authorized representative, someone you have named to act on your behalf, may file an appeal. To appoint an authorized representative, you must sign an authorization form and mail or fax the signed form to the address or phone number listed above. This release provides us with the authorization for this person to appeal on your behalf and allows our release of information, if any, to them. Please call us for an Authorization for Release form. You can also obtain a copy of this form on our web site at xxx.xxxx.xxx. You or your authorized representative may file an appeal by calling Customer Service or by writing to us at the address listed below. We must receive your appeal request as follows: For a Level I appeal, within 180 calendar days of the date you were notified of the adverse benefit determination; and For a Level II appeal, within 60 calendar days of the date you were notified of the Level I determination. If you are hospitalized or traveling, or for other reasonable cause beyond your control, we will extend this timeline up to 180 calendar days to allow you to obtain additional medical documentation, physician consultations or opinions. You may submit your written appeal request to: If you need help filing an appeal, or would like a copy of the appeals process, please contact the CHPW customer service team at 1‐800‐930‐0132, Monday through Friday from 8am to 5pm, or email xxxxxxxxxxxx@xxxx.xxx. If you are hearing or speech impaired, please call TTY 1‐866‐816‐2479 (toll free) or local 206‐613‐8875. You can also get a description of the appeals process by visiting our web page at xxx.xxxx.xxx.
Filing Appeals. (i) DVHA must allow beneficiaries to file appeals. DVHA must also allow providers, or authorized representatives, acting on behalf of the beneficiary and with the beneficiary's written consent, to request an appeal. DVHA must consider the beneficiary, his/her representative, or the legal representative of a deceased beneficiary’s estate as parties to an appeal.
(ii) Appeals may be filed within 60 calendar days from the date on the adverse benefit determination notice.
(iii) Beneficiaries, or their providers or authorized representatives, may file appeals orally or in writing for any DVHA adverse benefit determination. Oral inquiries to an internal appeal of an adverse benefit determination must be treated as appeals to establish the earliest possible filing date.
(iv) DVHA must provide each beneficiary seeking an appeal a reasonable opportunity, in person and in writing, to present evidence and testimony and make legal and factual arguments.
(v) DVHA must provide each beneficiary and his or her representative with the beneficiary's case file (including medical records, other documents and records, and any new or additional evidence considered, relied upon, or generated by DVHA (or at the direction of DVHA)) in connection with the appeal of an adverse benefit determination. DVHA must provide the case file free of charge and sufficiently in advance of the resolution timeframe for standard and expedited appeal resolutions.
