Examples of Claims Review Committee in a sentence
Any question of interpretation, construction, application or enforcement of the terms of the Plan and this SPD, and all determinations on benefit claims and appeals, are subject to the discretion of the Board of Trustees and/or its Claims Review Committee, whose determinations are final and binding.
If you have presented a claim for benefits under this SPD, you may file a request for review of its disposition or adverse benefit determination by appealing to the Claims Review Committee of the Board of Trustees of the UFCW National Health and Welfare Fund in writing, within 180 days after receiving written notice of the Fund's action.
At any time, the Claims Review Committee may refer a request for review to the Board of Trustees of the Fund.
You will be notified, in writing, of the decision of the Claims Review Committee within 60 days of the date your request for review is received, unless there are special circumstances, in which case you will be so notified and then notified of the decision within 120 days.
In deciding any appeal based in whole or in part on a medical judgment, the Claims Review Committee or Board of Trustees shall consult with a health care professional who has appropriate training and experience in the field of medicine involved in the medical judgment and who was neither consulted in connection with the adverse benefit determination nor the subordinate of any such individual.
The decision of the Claims Review Committee on a request for review will be final and binding if not timely appealed.
Any question of interpretation, construction, application or enforcement of the terms of the Plan and SPD, and all determinations on benefit claims and appeals, are subject to the discretion of the Board of Trustees and/or its Claims Review Committee, whose determinations are final and binding.
In deciding claims, the Claims Review Committee and the Board of Trustees have broad discretion to interpret and apply the terms of this plan and SPD.
Your decision as to whether or not to voluntarily submit a benefit dispute to the Board of Trustees after the Decision of the Claims Review Committee will have no effect on your right to any other benefits under the Fund.
The Fund waives any right to assert that you failed to exhaust administrative remedies because you did not elect to voluntarily submit your appeal to the Board of Trustees after the Decision of the Claims Review Committee.