Procedural Defects Clause Samples

Procedural Defects. If a Pre-service Claim submission is not made in accordance with the plan's requirements, Humana will notify the Claimant of the problem and how it may be remedied within five (5) days (or within 24 hours, in the case of an Urgent-care Claim). If a Post-service Claim is not made in accordance with the plan's requirement, it will be returned to the submitter. A covered person may designate an authorized representative to act on his or her behalf in pursuing a benefit claim or appeal. The authorization must be in writing and authorize disclosure of health information. If a document is not sufficient to constitute designation of an authorized representative, as determined by Humana, the plan will not consider a designation to have been made. An assignment of benefits does not constitute designation of an authorized representative. • Any document designating an authorized representative must be submitted to Humana in advance or at the time an authorized representative commences a course of action on behalf of the covered person. Humana may verify the designation with the covered person prior to recognizing authorized representative status. • In any event, a health care provider with knowledge of a covered person's medical condition acting in connection with an Urgent-care Claim will be recognized by the plan as the covered person's authorized representative. Covered persons should carefully consider whether to designate an authorized representative. Circumstances may arise under which an authorized representative may make decisions independent of the covered person, such as whether and how to appeal a claim denial.

Procedural Defects. 15.11.1 The parties to a grievance may agree to extend any time limits specified in this Article. The arbitrator shall have the power to relieve against non-compliance with any time limit. 15.11.2 A request to extend the time limit in Article 15.5 above for a period of not more than twenty (20) days shall not be unreasonably refused. 15.11.3 No minor technical or clerical violation in the grievance procedure or any document required by it shall prevent a grievance from being heard on its merits or affect the jurisdiction of the arbitrator. Last Revised January 26, 2000

Procedural Defects. 17.8.1 The parties to a grievance may agree to extend any time limits specified in Article

Procedural Defects. 15.11.1 The parties to a grievance may agree to extend any time limits specified in this Article. The arbitrator shall have the power to relieve against non-compliance with any time limit except those provided in Article 15.7.3. 15.11.2 A request to extend the time limit in Article 15.5 above for a period of not more than twenty (20) days shall not be unreasonably refused. 15.11.3 No minor technical or clerical violation in the grievance procedure or any document required by it shall prevent a grievance from being heard on its merits or affect the jurisdiction of the arbitrator. 16.1 Subject to the provisions of this Agreement and except as specifically agreed between the Parties, all recognized existing practices affecting the terms or conditions of employment of Members of the Bargaining Unit shall remain in effect and unaltered during the term of the Agreement and any extension thereof. 16.2 Recognized existing practices" are those practices which are identifiable, certain, known and in force as at September 1, 1995 or such other practices as the Parties may identify. 16.3 The onus to show that such a practice exists rests upon the person seeking to rely upon the practice.

Procedural Defects. The parties to a grievance may agree to extend any time limits specified in this Article. The arbitrator shall have. the power to relieve against non- compliance with any time limit. A request to extend the time limit in Article above for a period of not more than twenty (20) days shall not be unreasonably refused. No minor technical or clerical violation in the grievance procedure or any document required by it shall prevent a grievance from being heard on its merits or affect the jurisdiction of the arbitrator. A Member may be disciplined only for just and sufficient cause, and only in accordance with the provisions of this Article. The only disciplinary measures that may be taken by the University against a Member are the following:

Procedural Defects. The parties to a grievance may agree to extend any time limits specified in Article The arbitrator shall have the power to relieve against non-compliance with any time limit. A request to extend the time limit in Article for a period of not more than fifteen (15) working days shall not be unreasonably refused. No minor technical or clerical violation in the grievance procedure or any document required by it shall prevent a grievance from being heard on its merits or affect the jurisdiction of the arbitrator.

Procedural Defects. If a Pre-service Claim submission is not made in accordance with the plan's requirements, Humana will notify the Claimant of the problem and how it may be remedied within five (5) days (or within 24 hours, in the case of an Urgent-care Claim). If a Post-service Claim is not made in accordance with the plan's requirement, it will be returned to the submitter. A covered person may designate an authorized representative to act on his or her behalf in pursuing a benefit claim, an internal appeal or an external review. The designation must be in writing and must be made by the covered person on Humana's Appointment of Representation (AOR) Form or on a form approved in advance by Humana. An assignment of benefits does not constitute designation of an authorized representative. Humana's AOR Form must be submitted to Humana at the time or prior to the date an authorized representative commences a course of action on behalf of the covered person. At the same time, the authorized representative should also provide notice of commencement of the action on behalf of the covered person to the covered person, which Humana may verify with the covered person prior to recognizing authorized representative status. In any event, a health care provider with knowledge of a covered person's medical condition acting in connection with an urgent-care claim will be recognized by the plan as the covered person's authorized representative. Covered persons should carefully consider whether to designate an authorized representative. An authorized representative may make decisions independent of the covered person, such as whether and how to appeal a claim denial.