Adjudication of Claims Sample Clauses

Adjudication of Claims. (a) The City and the Union agree that Employee Health and Wellness will continue to adjudicate "Wage Continuance" claims as per current practice. This includes but is not limited to 1. Validating claims, 2. Investigating fraud, 3. Ensuring proper medical treatment is sought. Employee Health and Wellness has the ability to reasonably request medical certification necessary for proper adjudication. (b) It is further agreed that any "Wage Continuance" claim which is denied may be referred to the Joint Benefits Review Committee for consideration and thereafter if appropriate, to the grievance procedure.

Adjudication of Claims. Solely to the extent required or permitted under applicable law governing the operations of the Public Entity (including Tex. Civ. Prac. & Rem Code ▇▇▇. §101.001 et. seq. (the Texas Tort Claims Act) and Tex. Loc. Gov’t Code ▇▇▇. §271.151 et. seq. (Adjudication of Claims Arising Under Written Contacts with Local Governmental Entities)), each party hereto irrevocably agrees not to claim or assert, for itself or its assets, immunity (sovereign or otherwise) from suit, execution, attachment (before or after judgment) or any other legal process arising out of this Agreement in respect of such party’s obligations hereunder.

Adjudication of Claims. 20. THIS COURT ORDERS that if a CMI Known Creditor (other than a CMI Employee) disputes the amount of the Claim as set out in the CMI General Notice of Claim, the CMI Known Creditor shall deliver to the CMI Entities a CMI Notice of Dispute of Claim which must be received by the CMI Entities by no later than the CMI Claims Bar Date. Such Person shall specify therein whether it disputes the value of the Claim for voting and/or distribution purposes. 21. THIS COURT ORDERS that if a CMI Known Creditor (other than a CMI Employee) does not deliver to the CMI Entities a completed CMI Notice of Dispute of Claim by the CMI Claims Bar Date disputing its Claim as valued by the CMI Entities for voting and distribution purposes, then such CMI Known Creditor shall be deemed to have accepted for voting and distribution purposes the valuation of the CMI Known Creditor’s Claim as set out in the CMI Notice of Claim, and such CMI Known Creditor’s Claim shall be treated as both a Voting Claim and a Distribution Claim. A CMI Known Creditor may accept a Claim for voting purposes as set out in the CMI Notice of Claim and dispute the Claim for distribution purposes in such CMI Known Creditor’s CMI Notice of Dispute of Claim provided that it does so by the CMI Claims Bar Date. A determination of a Voting Claim of a CMI Known Creditor does not in any way affect and is without prejudice to the process to determine such CMI Known Creditor’s Distribution Claim. 22. THIS COURT ORDERS that if a CMI Employee: (i) disputes the amount of the Claim in respect of Wages and Benefits as set out in the CMI Employee Notice of Claim; and/or (ii) believes that they have a Claim other than in respect of Wages and Benefits, the CMI Employee shall deliver to the CMI Entities a CMI Notice of Dispute of Claim which must be received by the CMI Entities by no later than the CMI Claims Bar Date. If such Person disputes the amount of the Claim in respect of Wages and Benefits as set out in the CMI Employee Notice of Claim, such Person shall specify therein whether it disputes the value of such Claim in respect of Wages and Benefits for voting and/or distribution purposes. 23. THIS COURT ORDERS that if a CMI Employee does not deliver to the CMI Entities a completed CMI Notice of Dispute of Claim by the CMI Claims Bar Date disputing its Claim in respect of Wages and Benefits as valued by the CMI Entities for voting and distribution purposes or asserting other Claims, then such CMI Employee shall be deemed to...

Adjudication of Claims. BCBSNC or its designee will adjudicate Claims for Covered Prescription Drug Services electronically submitted by Network Participants through the Claims Adjudication System or manually submitted by a Member as a Paper Claim, according to the Group Health Plan, Member eligibility, and other information submitted by the Plan Administrator. In adjudicating claims, BCBSNC will rely on the information provided to it by the Plan Administrator and will not be responsible for inaccuracies in the information. Adjudication will include eligibility and coverage determination under the Group Health Plan, including the calculation of allowable costs and applicable Copayment/Deductible, or Coinsurance, payment of eligible claims, and notification of declined or ineligible Claims.

Adjudication of Claims. The Committee shall have full and complete discretionary authority to make all determinations as to the right to Benefits under the Plan. In the event that a Participant believes he has not received the Benefits to which he is entitled under the Plan, a claim shall be made in writing to the Committee. The claim shall be reviewed by the Committee. If the claim is approved or denied, in full or in part, the Committee shall provide a written notice of approval or denial within 90 days with, in the case of a denial, the specific reasons for the denial and specific reference to the provisions of the Plan and/or Agreement upon which the denial is based. A claim shall be deemed denied if the Committee does not take any action within the aforesaid 90 day period. If a claim is denied or deemed denied and a review is desired, the Participant shall notify the Committee in writing within 60 days of the receipt of notice of denial or the date on which the claim is deemed to be denied, as the case may be. In requesting a review, the Participant may review the Plan or any document relating to it and submit any written issues and comments he may deem appropriate. The Committee shall then review the claim and provide a written decision within 60 days. This decision, if adverse to the Participant, shall state the specific reasons for the decision and shall include reference to specific provisions of the Plan and/or Agreement on which the decision is based. The Committee's decision on review shall be final and binding.

Adjudication of Claims. Blue Cross NC or its designee will adjudicate Claims for Covered Prescription Drug Services electronically submitted by Network Participants through the Claims Adjudication System or manually submitted by a Member as a Paper Claim, according to the Group Health Plan, Member eligibility, and other information submitted by the Plan Administrator. In adjudicating claims, Blue Cross NC will rely on the information provided to it by the Plan Administrator and will not be responsible for inaccuracies in the information. Adjudication will include eligibility and coverage determination under the Group Health Plan, including the calculation of allowable costs and applicable Copayment/Deductible, or Coinsurance, payment of eligible claims, and notification of declined or ineligible Claims.

Adjudication of Claims. 5.4.1 Adjudicating and processing claims of Members at the appropriate price, based on the agreement between WellPoint and the pharmacy provider, at the point-of-sale. 5.4.2 Administering Members' respective individual transitional assistance subsidies, including roll over funds, as described in 42 CFR 403.808. 5.4.3 Obligating Network Pharmacies to comply with the requirements of the Program, including providing the lower of the negotiated price or usual and customary price to Members when a Covered Discount Card Drug for a negotiated price is available at the point-of-sale.

Adjudication of Claims. The Settlement Administrator shall verify that each person who timely submits a Claim is a Settlement Class Member and shall determine whether and to what extent the Claim reflects valid Ordinary Expenses and/or Extraordinary Expenses that are reasonably traceable to the Data Security Incident, including any Claim for Time Spent. The Settlement Administrator shall determine whether a Settlement Class Member’s supporting materials are sufficient to support a Claim and the amount of such a Claim and shall use reasonable procedures to screen Claims for abuse, fraud, duplication, reimbursability through other means, or ineligibility. 1. To the extent the Settlement Administrator determines a Claim Form, along with supporting materials, is materially deficient in whole or part, within a reasonable time of making such a determination, the Settlement Administrator shall notify the Settlement Class Member of the deficiencies and give the Settlement Class Member twenty-one (21) days to cure the deficiencies. If the Settlement Class Member attempts to cure the deficiencies but, at the sole discretion and authority of the Settlement Administrator, fails to do so, the Settlement Administrator shall notify the Settlement Class Member of that determination within ten (10) days of the determination. The Settlement Administrator may consult with Class Counsel and Defendant’s Counsel in making such determinations. 2. Defendant may object to any Claim, with notice to Plaintiffs’ counsel, and provide proof to the Settlement Administrator that the claimant’s representations are not accurate and/or the Claim is not entitled to compensation under the terms of the Settlement Agreement. Plaintiffs’ counsel shall be provided the opportunity to address the objection. 3. Ordinary Expenses, Extraordinary Expenses and Time Spent shall be deemed reasonably traceable to the Data Security Incident if the expenses (i) occurred after the Data Security Incident, (ii) involved or related to the type of Personal Identifying Information inadvertently disclosed in the Data Security Incident, and (iii) the Settlement Administrator determines that it is more likely than not reasonably traceable to the Data Security Incident. 4. No decisions by the Settlement Administrator shall be deemed to constitute a finding, admission, or waiver by WM as to any matter of fact, law, or evidence having any collateral effect on any Claim hereunder or in any other proceeding or before any other forum or authority...

Adjudication of Claims. All claims administered under this Agreement shall be adjudicated in accordance with the terms and conditions of the applicable policy, contract or plan document, subject to Southern’s right to approve or reasonably reject any decision concerning approval, settlement or denial of any claim in accordance with the terms and conditions of such policy, contract or plan document.