Denials A claim denial, also known as an adverse benefit determination, is any of the following: • a full or partial denial of a benefit; • a reduction of a benefit; • a termination of a benefit; • a failure to provide or make a full or partial payment for a benefit; and • a rescission of coverage, even if there is no adverse effect on any benefit. If we deny payment for a service we determine not medically necessary, a determination letter will be provided with the following information: • reason for the denial; • clinical criteria used to make the determination as well as how to obtain a copy of the clinical criteria; and • instructions for filing a medical appeal.
Eye Examinations All represented employees, who are health service system members, shall be eligible for one (1) annual VDT examination and prescribed eyewear.
Reversals In the event that the Receiver purchases an Asset (and assumes the Related Liability) that it is not required to purchase pursuant to this Section 3.4, the Assuming Institution shall repurchase such Asset (and assume such Related Liability) from the Receiver at a price computed so as to achieve the same economic result as would apply if the Receiver had never purchased such Asset pursuant to this Section 3.4.
Alternate Billed Calls 1.1 The Parties will engage in settlements of intraLATA intrastate alternate-billed calls (e.g., collect, calling card, and third-party billed calls) originated or authorized by their respective Customers in accordance with an arrangement mutually agreed to by the Parties.
Rehearsals Employees engaged casually for rehearsals shall be paid as set out in Table C of Schedule 1.
Insurance Claims The Supplier shall promptly notify to insurers any matter arising from, or in relation to, the Goods and/or Services and/or this Framework Agreement for which it may be entitled to claim under any of the Insurances. In the event that the Authority receives a claim relating to or arising out of the Goods and/or Services or this Framework Agreement, the Supplier shall co-operate with the Authority and assist it in dealing with such claims including without limitation providing information and documentation in a timely manner. Except where the Authority is the claimant party, the Supplier shall give the Authority notice within twenty (20) Working Days after any insurance claim in excess of £30,000 relating to or arising out of the provision of the Goods and/or Services or this Framework Agreement on any of the Insurances or which, but for the application of the applicable policy excess, would be made on any of the Insurances and (if required by the Authority) full details of the incident giving rise to the claim. Where any Insurance requires payment of a premium, the Supplier shall be liable for and shall promptly pay such premium. Where any Insurance is subject to an excess or deductible below which the indemnity from insurers is excluded, the Supplier shall be liable for such excess or deductible. The Supplier shall not be entitled to recover from the Authority any sum paid by way of excess or deductible under the Insurances whether under the terms of this Framework Agreement or otherwise. The Supplier To indemnify the Insured in respect of all sums which the Insured shall become legally liable to pay as damages, including claimant's costs and expenses, in respect of accidental: death or bodily injury to or sickness, illness or disease contracted by any person; loss of or damage to property; happening during the period of insurance (as specified in Paragraph 5 of this Annex 1 to this Schedule 14) and arising out of or in connection with the provision of the Goods and/or Services and in connection with this Framework Agreement. Not less than £10,000,000 in respect of any one occurrence, the number of occurrences being unlimited, but £10,000,000 in any one occurrence and in the aggregate per annum in respect of products and pollution liability. United Kingdom
WAGES AND CLASSIFICATIONS 42.01 The classification and wages for persons covered by the Collective Agreement shall, during the term of the Agreement, be as set out in Schedule "D" attached hereto.
42.02 Where a Child and Youth Worker II or III, who has a minimum of three (3) years continuous service in his/her current position wishes, for the purposes of career development and experience to apply for a Child and Youth Worker position which is classified one level lower, s/he may apply to the Chief Human Resources Officer to have this position considered as a secondment for a maximum of one (1) year through which s/he will retain his/her current salary.
(a) If a new job is established by the Employer, the Joint Job Evaluation Committee will evaluate the job. In circumstances where it is impossible for either party to convene the Joint Job Evaluation Committee, or a rating cannot be agreed upon prior to the posting of a newly created job, the Employer will set the initial wage rate. It is agreed that the newly created job will be reviewed by the Joint Job Evaluation Committee no later than three (3) months after the date that the new job is posted, unless otherwise agreed. Any increase in rate of pay resulting from such a review shall be retroactive to the start date(s) of the employee(s) in the new position. In the event that the rate of pay decreases, any decrease shall not apply to present incumbents. If the parties are unable to agree upon the rate of pay, the procedure set out in Article 42.04 shall apply. At the request of either party, all newly created jobs shall be re-reviewed by the Joint Job Evaluation Committee within twelve (12) months of the start date of the new job. Any increase in rate of pay resulting from such a review shall be retroactive to the start of the new job. In the event that the rate of pay decreases, any decrease shall not apply to present incumbents. If the parties are unable to agree upon the rate of pay, the procedure set out in Article 42.04 shall apply.
(b) Where the duties and responsibilities of an employee’s job are changed by the Employer in a substantive manner, so that a job is no longer properly classified and the rate should be changed, either the employee or the Employer may request that the job be reviewed by the Joint Job Evaluation Committee. Any such request must be made within six (6) months of the changes to the duties and responsibilities being made by the Employer. The job will be reviewed by the Joint Job Evaluation Committee no later than three (3) months after the request. It is understood that the cumulative effect of small changes may result in change “in a substantive manner”. Any increase in rate of pay resulting from such a review shall be retroactive to the date that the request was made which resulted in a re- classification. In the event that the rate of pay decreases, any decrease shall not apply to present incumbents. If the parties are unable to agree upon the rate of pay under a changed job as referred to above, the procedure set out in Article 42.04 shall apply with the appropriate changes. No job will be reviewed under section (b) more than once every twelve
Processing Grievances The grievant shall be granted reasonable time off with pay from regularly scheduled duty hours to process a grievance, provided that the time off will be devoted to the prompt and efficient investigation and handling of grievances, subject to the following: Neither a grievant nor a grievant's representative who is a Court employee shall suffer any lost pay for attending any regularly scheduled grievance hearing required by the procedure herein set forth.
A. A grievant and a grievant's representative shall notify their supervisor as soon as possible of scheduled grievance hearings and of any changes in the time or date of scheduled hearings in which they must participate.
B. In no event shall a grievant be represented by more than one Court employee at a grievance hearing.
Wages and Classification Premiums Provisions under these headings shall remain unchanged and are repeated as 20.04, except to the extent that the Wage Schedule referred to in the hospital's expiring collective agreement shall be adjusted and retroactivity shall be paid in accordance with the Implementation Agreement signed.
EMPLOYEE EVALUATIONS 6.1 Administrators will meet with new employees to discuss their job description within one (1) month of hire. The Administrator and new employee will sign off on the job description and it will be forwarded to the Human Resources Department for inclusion in the employee‘s personnel file. The Human Resources Department will compile and distribute a list showing each employee‘s evaluator prior to November 1st of each year. Bargaining unit job descriptions will be made available via the District‘s web site.
6.2 Evaluations will transpire as follows for employees that are receiving satisfactory ratings:
a. New hires—regular part-time (school year employees) will be evaluated at three (3) and six (6) working months.
b. New hires—full time (12 month employees) will be evaluated at three (3), six (6) and twelve (12) months.
c. After the initial year of employment, each employee shall be evaluated at least once annually by March 31st.
6.3 Criteria for evaluating bargaining unit members will be based on the performance categories outlined on the evaluation form as related to the job description of their specific position assignment.
6.4 Evaluation reports shall include feedback regarding strengths and weaknesses (if any) demonstrated by the employee. Prior to an employee receiving a rating less than “Meets Expectations,” the employee shall be advised of the performance concern and provided with a clear statement of any deficiency and a statement defining acceptable performance. This shall occur within a reasonable time prior to the final evaluation to allow the employee a chance to demonstrate improvement.
6.5 In the event an employee is evaluated overall as “Does Not Meet Expectations,” the district, in consultation with the employee and the Association, will provide the employee a written plan of improvement (See Employee Plan of Improvement form in Appendix). The plan shall clearly define all areas of deficiency, provide clear and attainable performance goals, and outline supports (if any) to be given, including any necessary training at the District’s expense. The employee will be given a reasonable amount of time, not to exceed sixty (60) working days, to meet job performance expectations. During the improvement period, feedback will be provided through a minimum of three scheduled meetings. Following the completion of the plan, the supervisor shall notify the employee in writing of the outcome. Failure to demonstrate satisfactory improvement may constitute grounds for termination.
6.6 The bargaining unit member shall be given a copy of their evaluation, and any data collection sheets (with the submitters name excluded) used in the evaluation.
6.7 Under the law there is no right to Association Representation at evaluation conferences.
6.8 Any information shared with the evaluating administrator for the evaluation process shall be recorded on Data Collection Sheet(s), with the exception of those unit members that have supervising teachers. Supervising teachers will work directly with the evaluating administrator to share performance information for inclusion in the unit member‘s evaluation.
6.9 Employees shall have the right to respond to evaluations in writing. Such written response shall be attached to the evaluation if received within 5 days.
6.10 No bargaining unit member shall be required to sign a blank or incomplete evaluation form.