Claims Review Process Clause Samples
The Claims Review Process clause establishes the procedures and requirements for evaluating and resolving claims made under a contract. Typically, it outlines the steps a party must follow to submit a claim, the documentation required, and the timeline for review and response by the other party or a designated authority. This clause ensures that any disputes or requests for additional compensation are handled in an organized and timely manner, reducing misunderstandings and facilitating fair resolution of issues that arise during the contract's performance.
Claims Review Process. The Settlement Administrator shall have the sole discretion and authority to determine whether and to what extent a Claim for Extraordinary Losses, Out-of-Pocket Losses, Lost Time, Credit Monitoring Services, or Cash Compensation is valid.
a. The Settlement Administrator will verify that each person who submits a Claim Form is a member of the Settlement Class.
b. The Settlement Administrator will determine that each Claim Form submitted by a Settlement Class Member was submitted during the Claims Period and is timely.
c. In determining whether claimed Extraordinary Losses or Out-of-Pocket Losses are more likely than not caused by or fairly traceable to the Security Incident, respectively, the Settlement Administrator will consider (i) the timing of the alleged loss and whether it occurred on or after September 30, 2022; (ii) whether the alleged loss involved the types of information that may have been affected in the Security Incident, including name, mailing address, Social Security number, and health insurance information; (iii) the explanation of the Settlement Class Member as to why the alleged loss is more likely than not caused by or fairly traceable to the Security Incident; and (iv) other factors the Settlement Administrator reasonably finds to be relevant.
d. The Settlement Administrator is authorized to contact any Settlement Class Member (by e-mail, telephone, or U.S. mail) to seek clarification regarding a submitted Claim prior to making a determination as to its validity.
e. No decision of the Settlement Administrator shall be deemed to constitute a finding, admission, or waiver by Defendants as to any matter of fact, law, or evidence having any collateral effect on any proceedings in any forum or before any authority.
f. To the extent the Settlement Administrator determines that a timely Claim for Extraordinary Losses, Out-of-Pocket Losses, Lost Time, Credit Monitoring Services, or Cash Compensation is deficient in whole or in part, the Settlement Administrator shall notify the Settlement Class Member of the deficiencies and provide the Settlement Class member twenty-one (21) days to cure the deficiencies. If the Settlement Administrator subsequently determines that the Settlement Class Member has not cured the deficiencies, the Settlement Administrator will notify the Settlement Class Member within the (10) days of that determination. The Settlement Administrator may consult with the Parties in making these determinations.
g. If a Settlement...
Claims Review Process. D.3.1 All Contractor Claims shall be referred to the Owner’s Authorized Representative for review. Contractor’s Claims, including Claims for additional compensation or additional Contract Time, shall be submitted in writing by Contractor to the Owner’s Authorized Representative within five (5) Days after a denial of Contractor’s initial request for an adjustment of Contract terms, payment of money, extension of Contract Time or other relief, provided that such initial request has been submitted in accordance with the requirements and within the time limits established in these General Conditions. Within thirty (30) Days after the initial Claim, Contractor shall submit to the Owner’s Authorized Representative, a complete and detailed description of the Claim (the “Detailed Notice”) that includes all information required by Section D.3.2. Unless the Claim is made in accordance with these time requirements, it shall be waived.
D.3.2 The Detailed Notice of the Claim shall be submitted in writing by Contractor and shall include a detailed, factual statement of the basis of the Claim, pertinent dates, Contract provisions which support or allow the Claim, reference to or copies of any documents which support the Claim, the dollar value of the Claim, and the Contract Time extension requested for the Claim. If the Claim involves Work to be completed by Subcontractors, the Contractor will analyze and evaluate the merits of the Subcontractor claim prior to forwarding it and that analysis and evaluation to the Owner’s Authorized Representative. The Owner’s Authorized Representative and the Owner will not consider direct claims from Subcontractors, suppliers, manufacturers, or others not a party to this Contract. Contractor agrees that it will make no agreement, covenant, or assignment, nor will it commit any other act that will permit or assist any Subcontractor, supplier, manufacturer, or other to directly or indirectly make a claim against Owner.
D.3.3 The Owner’s Authorized Representative will review all Claims and take one or more of the following preliminary actions within ten (10) Days of receipt of the Detailed Notice of a Claim: (1) request additional supporting information from the Contractor; (2) inform the Contractor and Owner in writing of the time required for adequate review and response; (3) reject the Claim in whole or in part and identify the reasons for rejection; (4) based on principles of equitable adjustment, recommend approval of all or part of t...
Claims Review Process. The Settlement Administrator shall review all submitted Claim Forms within a reasonable time to determine each Claimant’s eligibility for class relief. To be considered an “Authorized Claimant,” a Claimant must submit a valid and timely Claim Form consistent with Section 4.1 and Facebook’s records must reflect that the Claimant appeared in a Sponsored Story on or before the date of entry of the Preliminary Approval Order. Starting forty-five
Claims Review Process. Contractor shall have a retrospective automated claims review process to examine patterns of subsequent fills for opioids and identify subsequent fills that exceed Contractor established limitations.
Claims Review Process. PG&E claims review requires seven (7) business days and can be iterative requiring multiple revisions be reviewed entailing additional review time before claim statements are approved. Claims are required to be adequately proven to ensure their accuracy. Requests for PG&E’s Marketing Review shall be done as follows: Email ▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇@▇▇▇.▇▇▇ the statement and the substantiation, calculation, methodology or a link to a reliable independent source (examples -- DOE, State of California, and EnergyStar) ahead of when final feedback is needed. Include background information needed for the review including, but not limited to, • The final format material will take (printed, electronic only, video, etc.) • How it will be used (at events, on website, etc.) • Any specific in-market times (for use at conference Feb 2-10, etc.)
Claims Review Process. All Contractor Claims shall be referred to the Owner’s Authorized Representative for review. Contractor’s Claims, including Claims for additional compensation or additional Contract Time, shall be submitted in writing by Contractor to the Owner’s Authorized Representative within five (5) Days after a denial of Contractor’s initial request for an adjustment of Contract terms, payment of money, extension of Contract Time or other relief, provided that such initial request has been submitted in accordance with the requirements and within the time limits established in these General Conditions. Within thirty (30) Days after the initial Claim, Contractor shall submit to the Owner’s Authorized Representative, a complete and detailed description of the Claim (the “Detailed Notice”) that includes all information required by Section D.3.2. Unless the Claim is made in accordance with these time requirements, it shall be waived.
Claims Review Process. D.3.1 All CM/GC Claims shall be referred to the City’s Authorized Representative for review. CM/GC’s Claims, including Claims for additional compensation or additional Contract Time, shall be submitted in writing by CM/GC to the City’s Authorized Representative within five (5) business days after a denial of CM/GC’s initial request for an adjustment of Contract terms, payment of money, extension of Contract Time or other relief, provided that such initial request has been submitted in accordance with the requirements and within the time limits established in these General Conditions. Within twenty
Claims Review Process. The Settlement Administrator shall have the sole discretion and authority to determine whether and to what extent a claim for Ordinary Losses, Lost Time, Extraordinary Losses, or Alternative Cash Payment is valid.
a. The Settlement Administrator will verify that each person who submits a Claim Form is a member of the Settlement Class.
b. The Settlement Administrator will determine that each Claim Form submitted by a Settlement Class Member was submitted during the Claims Period and is timely.
c. In determining whether claimed Ordinary Losses and Extraordinary Losses are more likely than not caused by the Security Incident, the Settlement Administrator will consider (i) the timing of the alleged loss and whether it occurred on or after February 2, 2023; (ii) whether the alleged loss involved the types of information that may have been affected in the Security Incident; (iii) the explanation of the Settlement Class Member as to why the alleged loss was caused by the Security Incident; and (iv) other factors the Settlement Administrator reasonably finds to be relevant.
d. No decision of the Settlement Administrator shall be deemed to constitute a finding, admission, or waiver by ▇▇▇▇▇▇▇ as to any matter of fact, law, or evidence having any collateral effect on any proceedings in any forum or before any authority.
Claims Review Process. Within five (5) business days of receipt of an Interest Claim or Individual Contest Payments Claim and related documentation from Trustee, Review Counsel shall approve a request for Contest Payments, unless, in the sole and reasonable judgment of Review Counsel, it concludes that all or a portion of the Claim for the requested Contest Payments should be denied because, pursuant to the underlying Benefits Arrangement(s) and/or the Agreement, (i) the Executive is not eligible to receive Contest Payments, (ii) there is no colorable argument of any kind to support the claim for Benefits underlying the Claim, or (iii) the advance or payment reimbursement requested is excessive in light of the nature and magnitude of the Claim, the likelihood of success on the merits or the available funds in the Trust. In the case of a determination under (iii), Review Counsel shall recommend an amount of the Contest Payments to be paid by Trustee.
Claims Review Process. All claims must be submitted via our ticket system from inside your Client Area. Claims will be acknowledged within three (3) business days and reviewed within ten (10) business days of receipt. Upon coming to a decision, the customer will be notified via the ticket system whether the appropriate service credit will be issued on the next invoice or reject the claim by specifying the basis for rejection. Exceptions Customer shall not receive any credits under this SLA if failures are caused by or associated with any of the following: Circumstances beyond CR SERVERS’ reasonable control, including, without limitation, acts of any governmental body, war, insurrection, sabotage, acts or omissions of third party not engaged or authorized by CR SERVERS, embargo, fire, flood, strike or other labor disturbance, interruption of or delay in transportation, unavailability of or interruption or delay in telecommunications or third party services, failure of third party software or inability to obtain raw materials, supplies, or power used in or equipment needed for provision of the Service Level Agreement. Scheduled maintenance (with 72 hours of confirmed notice of having received notification and anticipated down time this might cause). Notifications will be sent via email to primary contact of account for such events and emergency maintenance. Any other acts or omissions of Customer or others authorized by Customer, including without limitation, any negligence, willful misconduct, or use of the CR SERVERS Network or CR SERVERS services in breach of CR SERVERS' Terms of Service Policies.