Claim Decision definition

Claim Decision means the document used by the Defendant to advise Claimants of whether and to what extent their claims are approved or denied.
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Claim Decision means a decision of the Claims Adjudicator to approve, deny or terminate a claim.
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Examples of Claim Decision in a sentence

  • Claim Decision TimeframeYou have 30 days from receiving a claim decision to accept, or the claim will be closed and the offer rescinded and case closed.

  • How to Appeal a Claim Decision How to Request an AppealIf you disagree with either a claim determination or a rescission of coverage determination, you can contact us in writing to formally request an appeal.Your request for an appeal should include: The patient's name and Policy number. The date(s) of Vision Service(s). The provider's name. The reason you believe the claim should be paid. Any documentation or other written information to support your request for claim payment.

  • Note that this caption differs from the Test Claim and the Parameters and Guidelines captions in that it includes only those sections that were approved for reimbursement in the Test Claim Decision.

  • Claim Decision - If we offer to cover a claim and the repair is not completed within 30 days the offer is automatically withdrawn and will not be paid.

  • Accept the reimbursement offered, which acceptance will be presumed if no completed Claim Decision and Option Selection Form or cure attempt is received by Settlement Administrator within 30 days of receipt of the letter.

  • In addition, travel and training costs are not included in the Parameters and Guidelines because those activities were not approved in the Test Claim Decision and the claimant did not request these costs as reasonably necessary to perform the mandated activity or submit substantial evidence to support such a request.

  • In particular, the Claim Decision or Review Decision shall state the number of squares (calculated in accordance with section6.2) with respect to which the Defendant shall be required to pay all or part of the costs of repairing or replacing the Damaged BP Organic Shingles (the “Approved Repairs”).

  • On July 24, 2020, the Commission on State Mandates (Commission) adopted the Test Claim Decision finding that Elections Code section 3010, as amended by Statutes 2018, chapter 120, imposes a reimbursable state-mandated program on cities and counties within the meaning of article XIII B, section 6 of the California Constitution and Government Code section 17514.

  • Where a claim has been rejected in whole or in part, the Claim Decision shall include a brief written explanation of the basis of the Claim Decision and information explaining the right of a Claimant to seek a review of the Claim Decision, in accordance with the terms of this Agreement.

  • Where a claim has been denied, the Claimant or any eligible successor may not submit another claim with respect to the BP Organic Shingles that were the subject of the claim for two years from the date of the Claim Decision, unless the Claimant or any eligible successor is experiencing actual water leakage as a result of a worsening of the conditions of the BP Organic Shingles, in which case the Claimant or any eligible successor can file a subsequentclaim immediately upon discovering the leak.

Related to Claim Decision

  • Final Decision means a final action of the commission determining the legal rights, duties, or privileges of any person. “Final decision” does not include preliminary, procedural, or intermediate actions by the commission, actions regulating the internal administration of the commission, or actions of the commission to enter into or refrain from entering into contracts or agreements with vendors to provide goods or services to the commission.

  • key decision * means an executive decision which is likely to:

  • Adverse decision means any decision by a review agent not to certify an admission,

  • return decision means an administrative or judicial decision or act, stating or declaring the stay of a third-country national to be illegal and imposing or stating an obligation to return;

  • Informed decision means a decision by a qualified patient to request and obtain a prescription for medication that the qualified patient may self-administer to end the qualified patient's life in a humane and dignified manner that is based on an appreciation of the relevant facts and that is made after being fully informed by the attending physician of:

  • Proposed decision means the presiding officer’s recommended findings of fact, conclusions of law, decision, and order in a contested case in which the administrator did not preside.

  • CPUC Decisions means CPUC Decisions 00-00-000, 00-00-000, 00-00-000, 00-00-000, 00-00-000, 00-00-000, 00-00-000, 00-00-000, 00-00-000, 00-00-000, 00-00-000, 00-00-000, 00-00-000, 00-00-000, 00-00-000, 00-00-000, 00-00-000, 00-00-000 and any other existing or subsequent decisions, resolutions or rulings related to resource adequacy, as may be amended from time to time by the CPUC.

  • Appellate Decision-maker means a person who considers and decides appeals of determinations regarding responsibility and dismissals of formal complaints. The Appellate Decision-maker cannot be the same person as the Title IX Coordinator, Investigator, or Decision-maker. The Appellate Decision-maker may be a school district employee, or a third party designated by the school district.

  • Indemnification Claim has the meaning set forth in Section 10.3.

  • Record of Decision means a Record of Decision of an application for municipal planning approval as contemplated in section 55;

  • Claim Notice has the meaning set forth in Section 8.4(a).

  • Review Panel means the panel, if any, appointed pursuant toRule 710 to review a completed Investigation Report and to determine whether a reasonable basis exists for finding a violation of the Rules and authorizing the issuance of a notice of charge pursuant to Rule 706.

  • Responsible Respondent means a Respondent that has the capability in all material respects to perform the scope of work and specifications of the Contract. In determining whether a Respondent is a Responsible Respondent, the Agency may consider various factors including, but not limited to, the Respondent’s competence and qualifications to provide the goods or services requested, the Respondent’s integrity and reliability, the past performance of the Respondent and the best interest of the Agency and the State.

  • Indemnified Claim has the meaning set forth in Section 8.2.

  • Response Action means the investigation, cleanup, removal, remediation, containment, control, abatement, monitoring of or any other response action to the presence of Regulated Substances or Contamination in, on, at, under or emanating from the Stadium Site, including the correction or abatement of any violation required pursuant to Environmental Laws or by a Governmental Authority.