Standard External Review. The Insured or Insured’s Authorized Representative may within four (4) months after receiving notice of an adverse determinat ion subject to this section, submit a request to OCHA for an External Review. All requests for standard external review must be made in writing to OCHA. OCHA will notify SHL and/or any other interested parties within one (1) business day after the receipt of the request for Ext ernal Review. Within five (5) business days after SHLreceives such notice and, subject to applicable Nevada law and regulation and pursuant to this section, SHLwill make a preliminary determination of whether the case is complete and eligible for External Review. Within one (1) business day of making such a determination, SHLwill notify in writing, the Insured or the Insured’s Authorized Representative and OCHA, accordingly. If SHL determines that the case is incomplete and/or ineligible, SHLwill notify the Insured in writing of such determination. Such notice shall include the required additional information or materials needed to make the request complete and, if applicable, state the reasons for ineligibility and also state that such determination may be appealed to OCHA.
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Standard External Review. The Insured or Insured’s Authorized Representative may within four (4) months after receiving notice of an adverse determinat ion determination subject to this section, submit a request to OCHA for an External Review. All requests for standard external review must be made in writing to OCHA. OCHA will notify SHL and/or any other interested parties within one (1) business day after the receipt of the request for Ext ernal External Review. Within five (5) business days after SHLreceives SHL receives such notice and, subject to applicable Nevada law and regulation and pursuant to this section, SHLwill SHL will make a preliminary determination of whether the case is complete and eligible for External Review. Within one (1) business day of making such a determination, SHLwill SHL will notify in writing, the Insured or the Insured’s Authorized Representative and OCHA, accordingly. If SHL determines that the case is incomplete and/or ineligible, SHLwill SHL will notify the Insured in writing of such determination. Such notice shall include the required additional information or materials needed to make the request complete and, if applicable, state the reasons for ineligibility and also state that such determination may be appealed to OCHA.
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