Compliance Dispute definition

Compliance Dispute includes (a) any threatened, pending or completed action, suit, proceeding, penalty, or alternative dispute resolution mechanism, whether civil, criminal, administrative, arbitrative, investigative or other, and whether made pursuant to federal, state or other law; or (b) any inquiry, hearing or investigation that Indemnitee determines might lead to the institution of any such action, suit, proceeding, penalty, or alternative dispute resolution mechanism.

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Compliance Dispute means (i) any claim that Company has failed in any manner to carry out any of its obligations under § 7 of this Agreement and (ii) any claim of the type described in §13(e)(2) of this Agreement that is not also any of the following: (A) a Released Claim, (B) a Retained Claim,

Compliance Dispute shall have the meaning set forth in Section 5.11(a).

Examples of Compliance Dispute in a sentence

• If the Second Alternate is unable or unwilling to serve in such role for any reason, then such Compliance Dispute Review Officer shall be a Person to be agreed upon by Company and Class Counsel prior to the Effective Date.

• If the First Alternate is unable or unwilling to serve in such role for any reason, then such replacement Compliance Dispute Review Officer shall be a Person to be agreed upon by Company and Class Counsel prior to the Effective Date (the “Second Alternate”).

• The Billing Dispute External Review Board or Boards (and its members and agents, if any), the Compliance Dispute Facilitator (and his agents, if any), the Internal Compliance Officer (and his agents, if any) and the Compliance Dispute Review Officer (and his agents, if any) do not owe a fiduciary duty to the Class Members, the Representative Plaintiffs, or Company.

• The Compliance Dispute Facilitator may issue a written explanation or a written order of the grounds for denial of Petitioner’s Compliance Dispute.

• All Parties agree that dispute resolution without invocation of the Compliance Dispute Review Officer’s authority is preferable, and all Parties further agree to assist the Compliance Dispute Facilitator in these efforts.

• If Class Counsel, or their designee, and Company cannot mutually agree on such replacement Compliance Dispute Review Officer, such replacement Compliance Dispute Review Officer shall be a Person to be agreed upon by Company and Class Counsel prior to the Effective Date (the “First Alternate”).

• Unless the Petitioner specifies otherwise, the Compliance Dispute Facilitator shall serve as the Petitioner’s representative in the Compliance Dispute process thereafter with respect to such Compliance Dispute.

• If in the Compliance Dispute Facilitator’s judgment Petitioner’s Compliance Dispute can be resolved using available resources without the invocation of the Compliance Dispute Review Officer’s authority, the Compliance Dispute Facilitator shall refer the Petitioner to the appropriate resources or otherwise assist in the resolution of Petitioner’s Dispute.

• Petitioner shall have no right to appeal the Compliance Dispute Facilitator’s decision.

• All Compliance Disputes shall be directed not to the Court nor to any other state court, federal court, arbitration panel or any other binding or non-binding dispute resolution mechanism but to the Compliance Dispute Facilitator to be designated by Class Counsel.

More Definitions of Compliance Dispute

Compliance Dispute means (i) any claim that CIGNA HealthCare has failed to carry out any of its obligations under Section 7 of this Agreement (with the exception of Section 7.29.f); provided, however, that none of the following shall be deemed a Compliance Dispute:

Compliance Dispute means any claim that Company has failed to carry out any of its obligations under this agreement; provided, however, that none of the following shall be deemed a Compliance Dispute: (a) a Released Claim, (b) a Retained Claim, (c) a Billing Dispute as defined in the Shane Settlement Agreement; and (d) a claim for which the Adverse Determination review process set forth in Section 7.11 of the Shane Settlement Agreement is available.

Compliance Dispute means any claim that Company has failed to carry out any of its obligations under § 7 of this Agreement (with the exception of

Compliance Dispute means any claim that Company has failed to carry out any of its obligations under § 7 of this Agreement (with the exception of § 7.29(f)); provided, however, that none of the following shall be deemed a Compliance Dispute: (a) a Released Claim; (b) a Retained Claim; (c) a Billing Dispute; and (d) a claim for which the Adverse Determination Review Process is available.

Compliance Dispute means (i) any claim that Company has failed in any manner to carry out any of its obligations under § 7 of this Agreement and (ii) any claim of the type described in §13(e)(2) of this Agreement that is not also any of the following: (A) a Released Claim, (B) a Retained Claim, (C) a Billing Dispute;(D) a claim for which the Medical Necessity External Review Process is available, or (E) a claim challenging a Medical Necessity determination arising out of administration of benefits for a Self-Funded Plan as to which the Plan Sponsor has not elected to participate in Company’s Medical Necessity External Review Process.