Sentences with phrase «in claims adjudication»

One of the major issues for injured workers from the late 1960s through the 1980s was the virtually hegemonic role played by doctors, who were employed full - time by the Workers» Compensation Board, in the claims adjudication process.

Not exact matches

These includes a proposal for legislation preventing the use of public money in settling sexual harassment claims, removal of forced arbitration provisions from employee contracts and a requirement that companies doing business with the state disclose the number of sexual harassment adjudications and nondisclosure agreements they've carried out.

In a previous role, Nicole built and scaled the team responsible for determining insurance products» coverage and corresponding claims adjudication.

In my proposal, the Treasury Secretary would initiate the process, but then would get handed off to a special bankruptcy court for adjudication of claims.

In the event that a claim for indemnification against such liabilities (other than the payment by the registrant of expenses incurred or paid by a trustee, officer or controlling person of the registrant in the successful defense of any action, suit or proceeding) is asserted by such trustee, officer or controlling person in connection with the securities being registered, the registrant will, unless in the opinion of its counsel the matter has been settled by controlling precedent, submit to a court of appropriate jurisdiction the question whether such indemnification by it is against public policy as expressed in such Act and will be governed by the final adjudication of such issuIn the event that a claim for indemnification against such liabilities (other than the payment by the registrant of expenses incurred or paid by a trustee, officer or controlling person of the registrant in the successful defense of any action, suit or proceeding) is asserted by such trustee, officer or controlling person in connection with the securities being registered, the registrant will, unless in the opinion of its counsel the matter has been settled by controlling precedent, submit to a court of appropriate jurisdiction the question whether such indemnification by it is against public policy as expressed in such Act and will be governed by the final adjudication of such issuin the successful defense of any action, suit or proceeding) is asserted by such trustee, officer or controlling person in connection with the securities being registered, the registrant will, unless in the opinion of its counsel the matter has been settled by controlling precedent, submit to a court of appropriate jurisdiction the question whether such indemnification by it is against public policy as expressed in such Act and will be governed by the final adjudication of such issuin connection with the securities being registered, the registrant will, unless in the opinion of its counsel the matter has been settled by controlling precedent, submit to a court of appropriate jurisdiction the question whether such indemnification by it is against public policy as expressed in such Act and will be governed by the final adjudication of such issuin the opinion of its counsel the matter has been settled by controlling precedent, submit to a court of appropriate jurisdiction the question whether such indemnification by it is against public policy as expressed in such Act and will be governed by the final adjudication of such issuin such Act and will be governed by the final adjudication of such issue.

In the event that a claim for indemnification against such liabilities (other than the payment by Registrant of expenses incurred or paid by a trustee, officer or controlling person of Registrant in the successful defense of any action, suit or proceeding) is asserted by such trustee, officer or controlling person in connection with the securities being registered, Registrant will, unless in the opinion of its counsel the matter has been settled by controlling precedent, submit to a court of appropriate jurisdiction the question whether such indemnification by it is against public policy as expressed in the 1933 Act and will be governed by the final adjudication of such issuIn the event that a claim for indemnification against such liabilities (other than the payment by Registrant of expenses incurred or paid by a trustee, officer or controlling person of Registrant in the successful defense of any action, suit or proceeding) is asserted by such trustee, officer or controlling person in connection with the securities being registered, Registrant will, unless in the opinion of its counsel the matter has been settled by controlling precedent, submit to a court of appropriate jurisdiction the question whether such indemnification by it is against public policy as expressed in the 1933 Act and will be governed by the final adjudication of such issuin the successful defense of any action, suit or proceeding) is asserted by such trustee, officer or controlling person in connection with the securities being registered, Registrant will, unless in the opinion of its counsel the matter has been settled by controlling precedent, submit to a court of appropriate jurisdiction the question whether such indemnification by it is against public policy as expressed in the 1933 Act and will be governed by the final adjudication of such issuin connection with the securities being registered, Registrant will, unless in the opinion of its counsel the matter has been settled by controlling precedent, submit to a court of appropriate jurisdiction the question whether such indemnification by it is against public policy as expressed in the 1933 Act and will be governed by the final adjudication of such issuin the opinion of its counsel the matter has been settled by controlling precedent, submit to a court of appropriate jurisdiction the question whether such indemnification by it is against public policy as expressed in the 1933 Act and will be governed by the final adjudication of such issuin the 1933 Act and will be governed by the final adjudication of such issue.

To the fullest extent permitted by law, by your access to the Sites, you agree that: (i) any claim, dispute or cause of action regarding the Sites or these Terms shall be brought individually (NOT AS PART OF A CLASS ACTION) in the federal or state courts of the State of New York, and, such claim / dispute / cause of action will be resolved by a judge and THE RIGHT TO A JURY TRIAL IS HEREBY EXPRESSLY WAIVED; (ii) you consent to the personal jurisdiction of such courts as the exclusive tribunal for adjudication of any such claim / dispute / cause of action, expressly waiving any right of forum non convenience, change of venue or like right; (iii) your recovery will be limited to actual out - of - pocket costs involved in specifically accessing the Sites (if any) and you expressly waive your right to all other forms of recovery, including by way of example only, punitive, consequential, indirect, incidental, special and exemplary damages as well as attorneys» fees for bringing such claim / dispute / cause of action; and (iv) the court shall apply the law of the State of New York in adjudicating any such claim / dispute / cause of action, except for the choice of law / conflict of law rules of the State of New York (or of any other jurisdiction which would result in the application of the law of any jurisdiction other than the State of New York).

It gives us processes for adjudicating truth claims, and imposes different evidentiary rules on adjudication depending on the context and consequences (in criminal law proof beyond a reasonable doubt; in civil law proof on the balance of probabilities).

... (1) to promote accuracy and certainty in the adjudication of claims; (2) to provide fairness to persons who might be required to defend against claims based on stale evidence; and (3) to prompt persons who might wish to commence claims to be diligent in pursuing them in a timely fashion Having regard to these principles, and on the basis of the facts before him, Justice Perell decided that the limitation period for the insured in Nasr began to run from the date upon which Intact formally denied the claim in July 2013.

Rights adjudication is no longer a mechanism that will allow those over whom power is claimed in the name of the collective to challenge the legitimacy of that claim, but instead, as Maus points out, «serves to empower and legitimate the state apparatus in programming itself».

He has been instructed both led and unled in the High Court and in substantial County Court claims, and as junior counsel in contractual adjudications.

To the surprise of many observers, including, presumably, the petitioner and respondent in Executive Benefits, whose Supreme Court briefing focused, for the most part, on the issue of consent, the Supreme Court chose not to address the question of whether a party's consent to bankruptcy court adjudication on a Stern Claim may operate to effectively negate any constitutional concerns.

Of note, in Martin v. Workers» Compensation Board, the Supreme Court of Canada interpreted sections 126 and 161 of the WSIA as indicating that the Ontario legislature, like all other provincial legislatures in Canada, «contemplate [d] the consistent adjudication of claims through the application of policies».

Jo specialises in adjudication both in bringing high value fee claim adjudications and defending professional negligence adjudications including a multi million pound double adjudication arising out of a high profile PFI project.

That said, I would venture that trial fairness should operate as the guiding principle in this area, so if the plaintiff has decided that expert evidence from one specialty based on an examination of the plaintiff is relevant to the adjudication of her claim at trial, courts should be loathe to deny the defence a fair opportunity to respond with expert evidence from the same specialty based on an assessment of the plaintiff.

The course is accredited by the Chartered Institute of Arbitrators and can lead to a second career in Arbitration, Adjudication, Mediation or Claims consultancy.

Pinsent Masons LLP remains at the forefront of contractor work in the UK, with the practice handling a high volume of adjudication and litigation claims for the likes of Balfour Beatty, Carillion and Kier Group.

The Court noted that although use of BRI in PTAB trials may result in some inconsistency with parallel district court actions, that risk «has long been present in our patent system, which uses different tracks — one in the Patent Office and one in the courts — for the review and adjudication of patent claims.»

Martin has over seven years of experience representing disability claimants, helping them navigate the disability claims process and representing them at hearings in the Office of Disability Adjudication and Review.

He specialises in all aspects of dispute resolution, particularly high value commercial and construction claims, involving arbitration, adjudication, mediation and High Court litigation.

But it is also true that they are both parts in delivering a unified message: that of the common law courts» endorsement, sometimes ringing and sometimes more muted, of the value of access by the citizens to the adjudication of rights claims.

An upstream party is only allowed to raise claims in adjudication «as a shield rather than as a sword».

A «smash and grab» adjudication is where a contractor claims the sum due stated in its interim application on the basis that no valid payment notice or pay less notice has been issued by the paying party.

Main findings from the review of caselaw on WSIB adjudication (see also Chart) point to the regular disregard of the treating health professional's medical opinion about whether return to work is safe; the reversal of benefits promised to the most vulnerable injured workers (those with permanent disabilities approaching «lock - in» of benefits); wrongful denial of compensation based on «little or no evidence» of pre-existing conditions; and undue targeting of workers with psychological injuries for denial of claims and for surveillance.

One stop shop adjudication service including claims preparation or defence by our in - house quantity surveyors

Applicants for the position must have a law degree with at least 15 years at the bar, experience as a member of the judiciary or in the adjudication of claims, and have significant knowledge of Canadian Aboriginal people and their history, culture and current issues.

«What's not in the judgment is my concern: a comedian comes under attack, claims protection under the Charter of Rights, and there's no adjudication on whether this is protected speech or whether discrimination is a reasonable limit on the expression of a comedian on stage,» Millar said in an interview.

The courts in Ontario have embraced the cultural shift endorsed by the Supreme Court of Canada and are interpreting the summary judgment rules broadly, and favouring proportionality and fair access to affordable, timely and just adjudication of claims.

Furthermore, trip interruption or evacuation are included in APRIL's signature «Stress Less» benefits, which bypass the frustrating claims process via instant adjudication of all applicable issues and inconveniences.

The definition of a «contributing entity» at § 153.20 provides that for the 2015 and 2016 benefit years, a contributing entity is (i) a health insurance issuer or (ii) a self - insured group health plan, including a group health plan that is partially self - insured and partially insured, where the health insurance coverage does not constitute major medical coverage, that uses a third party administrator (TPA) in connection with claims processing or adjudication, including the management of internal appeals, or plan enrollment for services other than for pharmacy benefits or excepted benefits within the meaning of section 2791 (c) of the PHS Act.

If you are searching for an experienced, knowledgeable and dedicated Health Insurance Management professional who will generate significant insight in client service and support, and develop and oversee successful claims systems and adjudication initiatives, please contact me to arrange an interview.

• Hands - on experience in handling claim denials and resubmissions using standard adjudication procedures.

* Adequate knowledge in Health Administration - Claims processing (auto adjudication), COB, EOB / Drafts, Claims pricing and testing, HIPAA, enrolment, EDI, HIX, HMO, PPO, POS, Medicare, Medicaid, CDHP, MMIS system implementatio...

New York State Office of Temporary and Disability Assistance, City • NY 1996 — 2007 Quality Assurance Analyst (2005 — 2007) Unit Manager (1999 — 2005) Reconsideration Analyst (1998 — 1999) Disability Analyst (1996 — 1998) Promoted to increasing levels of responsibility and challenge with oversight of daily operation and production of 8 - member unit in administration and adjudication of Social Security Disability claims under Titles II and XVI of the Social Security Act for the States of New York, New Jersey, Maryland and Florida.

Multi-faceted, knowledgeable, and detail - oriented Benefit / Claims Management professional with extraordinary track record of assisting in all aspects of CI claim management / adjudication, eager to contribute advanced business acumen, claim support services, and industry knowledge, toward optimizing the goals of a world - class organization in a Benefit / Claims Consultant role.

Professional Experience St. Mary's Home Care / Infinite Wellness / Concept's Family Care Net (Raleigh, NC) 01/2010 — Present Agency Manager & Billing Specialist • Manage and train team members in company policies, procedures, and industry best practices • Research, analyze and resubmit denied claims for adjudication in a timely and professional manner • Oversee the billing process including coding, keying, and submission of new billings • Communicate with clients on billing errors and corrective action plans

Professional Experience Blue Cross of California (Pomona, CA) 2005 — Present Claims Examiner / Customer Service Representative • Research, analyze, code, and process claims for payment in a timely, accurate, and organized manner • Adjust, void, and reopen claims as needed to ensure proper adjudication • Resolve inquiries, issues, and adjustments regarding benefits, policies and contracts • Oversee and support special customer service and claims related initiatives • Provide exceptional in person, telephone, and email customer service ensuring client satisfaction • Train junior team members in industry best practices and corporate protocols • Offer additional administrative support including filing, data entry, and inventory manaClaims Examiner / Customer Service Representative • Research, analyze, code, and process claims for payment in a timely, accurate, and organized manner • Adjust, void, and reopen claims as needed to ensure proper adjudication • Resolve inquiries, issues, and adjustments regarding benefits, policies and contracts • Oversee and support special customer service and claims related initiatives • Provide exceptional in person, telephone, and email customer service ensuring client satisfaction • Train junior team members in industry best practices and corporate protocols • Offer additional administrative support including filing, data entry, and inventory manaclaims for payment in a timely, accurate, and organized manner • Adjust, void, and reopen claims as needed to ensure proper adjudication • Resolve inquiries, issues, and adjustments regarding benefits, policies and contracts • Oversee and support special customer service and claims related initiatives • Provide exceptional in person, telephone, and email customer service ensuring client satisfaction • Train junior team members in industry best practices and corporate protocols • Offer additional administrative support including filing, data entry, and inventory manaclaims as needed to ensure proper adjudication • Resolve inquiries, issues, and adjustments regarding benefits, policies and contracts • Oversee and support special customer service and claims related initiatives • Provide exceptional in person, telephone, and email customer service ensuring client satisfaction • Train junior team members in industry best practices and corporate protocols • Offer additional administrative support including filing, data entry, and inventory manaclaims related initiatives • Provide exceptional in person, telephone, and email customer service ensuring client satisfaction • Train junior team members in industry best practices and corporate protocols • Offer additional administrative support including filing, data entry, and inventory management

Carolina Health Specialist (Myrtle Beach, SC) 09/1998 — 03/2000 Insurance Coordinator / Supervisor • Manage the billing of commercial, Medicare, and Medicaid claims to insurance carriers • Perform research, follow up, and appeals on unprocessed claims for payment adjudication • Serve as team trainer instructing junior associates in corporate policies and industry best practices • Create audit reports, manage time cards, and monitor weekly logs for team productivity • Oversee talent recruitment ensuring a highly qualified and effective team

Professional Experience Accenture (City, ST) Date — Date Lean Six Sigma (LSS) Consultant • Supported the United States Postal Service Continuous Improvement Office and Retail Service Area • Led a ZIP - Forward project validating the accuracy of POS originating Priority Mail data • Supported the United States Postal Service Finance Remediation and Compliance team • Directed ZIP - Forward project to define the Business Reply Mailer process and identify revenue leakage • Created a strategic roadmap of improvements for a new operational and financial processes • Reduced the risk of revenue loss and establish metrics for process analysis and benchmarking • Supported United States Postal Service Global Claims Accounting Services Group • Managed a ZIP - Forward Event to reduce claim backlog and overall adjudication process time • Improved mediation strategy and mitigation plan to assist in SOX certification • Provided coaching on LSS theories, methodologies, and tools to ZIP - Forward project team • Mentored a USPS employee to achieve Green Belt status