Claims Examiner definition

Claims Examiner means anyone who has primary responsibility for decision making or benefit determination in a claim. This would include those who decide compensability of new claims or aggravations, calculate benefits, authorize payments, or who represent employers by direct contact with the Department or Board. This definition does not include attorneys representing employers before the Department or Board, or those who primarily perform clerical functions.

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Claims Examiner has the meaning defined in Section 4.1(1);

Claims Examiner means staff employed by Zenith to process claims.

Examples of Claims Examiner in a sentence

• In any event, notwithstanding anything to the contrary contained in this Article 12, if the Claims Examiner has not issued its decision within thirty (30) Days of the Detailed Claim being filed, that Claim shall be subject to appeal and submitted to non-binding mediation all as set forth below.

• Some could include but is not limited to positions such as: Accountant, Claims Examiner, and Executive Assistant.

• However, only correspondence that includes initial analysis, deposition summaries, medical report findings, hearings, notices of appointments of QME, AME and depositions, settlement demand and or requests should be emailed to the Claims Examiner, County’s Workers’ Compensation Program Manager and Sedgwick Claims mail.

• Drafts of settlement documents (e.g., Stipulations with Request for Award, Compromise and Release, etc.) shall be sent to the Claims Examiner for review/approval prior to submission to interested parties for execution.

• Requests for further discovery (e.g., photocopy of records, client documents, investigation/surveillance, deposition, medical-legal evaluations, appeals) shall be directed to the TPA Claims Examiner by email with a copy to ▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇▇▇▇.▇▇▇ (the entity responsible for the central scanning for the claim file).

• If there is no response from the Claims Examiner to any written or verbal request for information and/or required authorization within a (15) fifteen- day period, the assigned attorney shall escalate to the Claims Examiner’s manager.

• Requests for settlement authorizations shall be emailed to the Claims Examiner with a copy to the Unit Manager and the TPA Program Manager as well as the County’s Workers’ Compensation Program Manager.

• Upon direction from the Claims Examiner to utilize a Panel Qualified Medical Evaluator (PQME), the panel must be requested within five (5) business days.

• Within ten (10) business days of receipt of maximal medical improvement (MMI)/permanent and stationary (P&S) report, the assigned attorney must request settlement authority with a full analysis of the claim or notify Claims Examiner and the County’s Workers’ Compensation Program Manager why the claim is not in posture for settlement.

• The defense attorney should promptly schedule a conference call with the Claims Examiner, Unit Manager and County’s Workers’ Compensation Program Manager to collaborate on a plan of action including the following: • Obtain approval to proceed with resolution from Claims Examiner/County Program Manager; if Applicant is current employee, voluntary resignation will be necessary.

More Definitions of Claims Examiner

Claims Examiner means Simone Lelchuck and Jed Melnick of Melnick ADR, LLP.

Claims Examiner means Jeffrey H. Beck, who was appointed as an independent fiduciary, entitled to his own attorney client privilege with his counsel, by the Court pursuant to that certain Order dated October 29, 2007, granting the motion to approve the SunTrust Settlement Agreement, pursuant to which he has full authority to (a) review and investigate Claims against the bankruptcy estate of either AMCAP or TFC Filed by an Insider of either AMCAP or TFC, or an Affiliate of such Insider and (b) review and negotiate the terms of the Plan.

Claims Examiner means staff employed by a Claims Administrator to process claims.

Claims Examiner means non-clinical personnel employed by Zenith to process claims. They do not perform any aspect of Utilization Review, in compliance with

Claims Examiner means staff employed by Zenith to process claims. They may review Treatment Requests for the purpose of rendering coverage determinations or application of prior determinations. Claims Examiners may not make medical necessity determinations including decisions to Certify, Non-Certify, delay, or modify a Treatment Request.

Claims Examiner means a claims examiner as defined under 39-71-116,