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

Plan Submission of Documents to the IRO. Upon assigning an IRO, The Plan will provide any documents and information considered in making the adverse benefit determination or the final internal adverse benefit determination to the assigned IRO electronically, by telephone, by facsimile, or by any other available expeditious method. Failure by The Plan to provide the documents and information may not delay the conduct of the external review. If The Plan fails to provide the documents and information upon IRO assignment, the assigned IRO may terminate the external review and decide to reverse the adverse benefit determination or final internal adverse benefit determination. Immediately upon making such a determination, the IRO will notify the Member or the Member’s authorized representative and The Plan accordingly.