Complaint or Grievance definition

Complaint or Grievance means written expression (includes communication in the form of electronic mail or other electronic scripts), of dissatisfaction by a complainant with insurer, distribution channels, intermediaries, insurance intermediaries or other regulated entities about an action or lack of action about the standard of service or deficiency of service of such insurer, distribution channels, intermediaries, insurance intermediaries or other regulated entities.
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Complaint or Grievance means an expression of dissatisfaction about any matter other than an action, as defined above. As provided by 42 C.F.R. Section 438.400, possible subjects for complaints or grievances include, but are not limited to, the quality of care of services provided, and aspects of interpersonal relationships such as rudeness of a provider or employee, or failure to respect the Member's rights. EMERGENCY MEDICAL CONDITION, means a medical condition manifesting itself by acute symptoms of recent onset and sufficient severity (including severe pain), such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical care could result in:
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Examples of Complaint or Grievance in a sentence

  • The Member may also file a written Complaint or Grievance with The Plan.

  • The Member will be notified of The Plan’s response within 60 days from receipt of the Member’s written Complaint or Grievance.

  • At any Complaint or Grievance Step of the grievance procedure, the time limits imposed upon either party may be extended by mutual agreement.

  • A If the grievor fails to act within the time limits set out at any Complaint or Grievance Step, the grievance will be considered abandoned.

  • If the grievor fails to act within the time limits set out at any Complaint or Grievance Step, the grievance will be considered abandoned.

  • A request for a DHS Fair Hearing does not prevent a Member from also utilizing the PH-MCO’s Complaint or Grievance process.

  • If an official fails to reply to a grievance within the time limits set out at any Complaint or Grievance Step, the grievor may submit his/her grievance to the next Step of the grievance procedure.

  • The Primary Contractor or its BH-MCO may not take any adverse action against a Provider for assisting a Member in the understanding of or filing of a Complaint or Grievance under the Member Complaint and Grievance system.

  • Members may not file a Complaint or Grievance with the PH-MCO regarding the restriction.

  • MA Participants may appeal a Lock-in by requesting a DHS Fair Hearing, but may not file a Complaint or Grievance with the CHC-MCO.

Related to Complaint or Grievance

  • A grievance means a dispute or disagreement as to the interpretation or application of terms and conditions of employment contained in this Agreement.

  • Grievance means a complaint in writing that an employee, group of employees, or the Union submits to management, to be processed through the grievance procedure.

  • Group Grievance is defined as a single grievance, signed by a Xxxxxxx or a Union Representative on behalf of a group of employee who have the same complaint. Such grievances must be dealt with at successive stages of the Grievance Procedure commencing with Step 1. The grievors shall be listed on the grievance form.

  • Policy Grievance shall be signed by a xxxxxxx or a Union representative or, in the case of an Employer's policy grievance, by the Employer or its representative.

  • Grievances filed under this Article shall begin at Step 2. Grievances under this clause shall be handled with all possible confidentiality and dispatch.

  • Complaint means any dissatisfaction expressed by a Complainant orally or in writing to HMO about any aspect of HMO’s operation, including, but not limited to:

  • Complaints means each of the following documents:

  • Complaints Procedure means the School's procedure for handling complaints from parents, as amended from time to time for legal or other substantive reasons, or in order to assist the proper administration of the School. It does not form part of the contract between you and the School. A copy of the most up-to-date procedure is on the School's website and is otherwise available from the School at any time upon request;

  • Statement of Grievance shall name the grievant(s) involved, the facts giving rise to the grievance, the provision(s) of the Agreement alleged to be violated, and the remedy (specific relief) requested.

  • Allegation means any written or oral statement or other indication of possible scholarly misconduct made to an institutional official.

  • Complaint Investigation means an investigation of any complaint that has been made to a proper authority that is not covered by an abuse investigation.

  • Grievance System means the overall system that includes:

  • Lawsuit means any lawsuit, arbitration or other dispute resolution filed by either party herein pertaining to any of this Warrant, the Facility Agreement and the Registration Rights Agreement.

  • Grievance Procedure is used in this Agreement, it shall be considered as including the arbitration procedure.

  • Grievant means an employee or group of employees having the same grievance. In the case of a group of employees, one employee shall be designated by the group to act as spokesperson and to be responsible for processing the grievance.

  • Legal Action means and includes any claim, counterclaim, demand, action, suit, counterclaim, arbitration, inquiry, proceeding or investigation before any

  • Labor dispute as used here, means a strike, lockout, or other labor dispute between the Employer and its Employees, during which time the Employee is not paid by the Employer.

  • third party proceeding means any threatened, pending or completed action, suit or proceeding, whether civil, criminal, administrative, or investigative, other than an action by or in the right of the corporation.

  • Attack directed against any civilian population means a course of conduct involving the multiple commission of acts referred to in paragraph 1 against any civilian population, pursuant to or in furtherance of a State or organizational policy to commit such attack;

  • Disciplinary proceeding means an adjudicative proceeding permitted under this

  • Product Complaint means any oral, electronic or written communication that alleges deficiencies related to the identity, quality, durability, reliability, safety, effectiveness or performance of a marketed product, including failure of the product, labelling or packaging to meet specifications, whether or not the product is related to or caused the alleged deficiency. A complaint may allege that an Adverse Event or Medical Device Malfunction (as defined herein) has occurred.

  • Violent juvenile felony means any of the delinquent acts enumerated in subsection B or C of

  • Material Action means to consolidate or merge the Company with or into any Person, or sell all or substantially all of the assets of the Company, or to institute proceedings to have the Company be adjudicated bankrupt or insolvent, or consent to the institution of bankruptcy or insolvency proceedings against the Company or file a petition seeking, or consent to, reorganization or relief with respect to the Company under any applicable federal or state law relating to bankruptcy, or consent to the appointment of a receiver, liquidator, assignee, trustee, sequestrator (or other similar official) of the Company or a substantial part of its property, or make any assignment for the benefit of creditors of the Company, or admit in writing the Company's inability to pay its debts generally as they become due, or take action in furtherance of any such action, or, to the fullest extent permitted by law, dissolve or liquidate the Company.

  • Complainant means an individual who is alleged to be the victim of conduct that could constitute sexual harassment.

  • legal or administrative action means any legal proceeding or arbitration and any administrative or regulatory action or investigation;

  • Indictment means a written statement, presented by a grand jury to the district court, which charges the commission of a crime by an alleged offender.