Common use of Plan Submission of Documents to the IRO Clause in Contracts

Plan Submission of Documents to the IRO. Within 5 business days after the date the IRO is assigned, The Plan must submit the documents and any information considered in making the benefits denial to the IRO. The Plan’s failure to timely provide such documents and information will not constitute cause for delaying the external review. If The Plan fails to timely provide the documents and information, the IRO may terminate the external review and reverse the adverse benefit determination or final internal adverse benefit determination. If the IRO does so, it must notify the Member and The Plan within 1 business day after making the decision.

Plan Submission of Documents to the IRO. Within 5 business days after the date the IRO is assignedassigning an IRO, The Plan must submit will provide to the assigned IRO any documents and any information considered in making the benefits denial to adverse benefit determination or the IROfinal internal adverse benefit determination. Failure by The Plan’s failure Plan to timely provide such the documents and information will may not constitute cause for delaying delay the conduct of the external review. If The Plan fails to timely provide the documents and informationinformation within 5 business days, the assigned IRO may terminate the external review and decide to reverse the adverse benefit determination or final internal adverse benefit determination. If Immediately upon making such a determination, the IRO does so, it must will notify the Member or the Member’s authorized representative and The Plan within 1 business day after making the of its decision.