A written complaint submitted by a member, which challenges any of the following: The insurers decisions, policies or actions related to availability, delivery or quality of health care services; claims payment or handling; reimbursement for services; the contractual relationship between the member and the insurer; or the outcome of an appeal of a noncertification decision NCGS 58-50-61(a)(6)
Complaints related to a specific situation or set of circumstances Striking workers often present their employers with a list of grievances such as poor working conditions, not enough time for lunch, etc
a formal complaint against a health plan, usually requiring a written complaint sent to a particular office Complaints can also be informally made over the telephone
A complaint about the way your Medicare health plan is giving care For example, you may file a grievance if you have a problem with the cleanliness of the health care facility, problems calling the plan, staff behavior, or operating hours A grievance is not the way to deal with a complaint about a treatment decision or a service that is not covered
A request by an enrollee or a health care provider, with written consent of the enrollee, to have the managed care plan or utilization review entity reconsider a decision solely concerning medical necessity and appropriateness of health care services If the managed care plan is unable to resolve the matter, a grievance may be filed regarding a decision that: (1) disapproves full or partial payment for requested health care services; (2) approves a provision of a requested health care service for a lesser scope or duration than requested; or (3) disapproves payment for provisions of a requested health care service but approves payment for provision of an alternative health care service The term does not include a complaint
means a complaint filed by a covered employee or the employee's representative regarding an adverse employment action designated in Section 8-17-330 of the SC Code of Laws
A difference or dispute between an employee and the school board or its supervisory representatives with respect to the applications of the school board's policies, rules, and regulations as they affect the work activity of such employees The grievance shall not refer to any matter on which the school board is without authority to act
means a written and signed request by an employee, or by a group of employees acting as individuals, for personal relief concerning a particular act or occurrence which arises during the employment of the employee(s) and is subject to the control of agency management [HRO Part 3, Chapter 2, Agency Grievance Procedure]
a complaint filed by a covered employee or the employees representative regarding an adverse employment action taken by an agency designated in § 8-17-330 of the South Carolina Code of Laws (S C Code Ann § 8-17-320 (11))
In labor law a complaint filed by an employee regarding working conditions to be resolved by procedural machinery provided in the union contract An injury, injustice, or wrong which gives ground for complaint
A specific complaint initiated by a non-probationary employee, group of employees or their authorized representative alleging that his or her employment has been, or is being, adversely affected by an improper application or interpretation of a university rule, regulation, policy, procedure, or practice or by a specified action of a supervisor that is contrary to university policy
a complaint about a (real or imaginary) wrong that causes resentment and is grounds for action an allegation that something imposes an illegal obligation or denies some legal right or causes injustice
The formal complaint of an eligible Classified Staff employee based on an action or circumstance regarded by the employee as being unjust- or adverse to the employee's welfare
An official written complaint to a housing authority because you believe that you have been discriminated against Then the housing authority has to decide if something wrong was done and if so, how to correct it You get a written answer Assisted-housing does not have official grievance proceedings, but you can make written complaints that get handled in a similar manner
This procedure is a function required by law which gives a dissatisfied member the opportunity to file a written complaint with the HMO and move through several administrative layers in an attempt to get the complaint resolved
A written complaint, made by either an employee, the union or the employer Such complaints are, in general, allegations that management, or an individual member of management or the union, has violated a legally binding term of a collective agreement
1) A complaint or protestation based on an actual or supposed circumstance regarded as just cause for protest 2) A formal complaint against management by an employee(s) or a union concerning an alleged breach of their collective agreement, legislation, or natural law The grievance procedure follows steps outlined in the collective agreement, the last step being compulsory grievance arbitration
A verbal or written expression of dissatisfaction with the quality of care or services provided This usually includes any complaints that are not considered to be an appeal
If you have a grievance about something that has happened or been done, you believe that it was unfair. They had a legitimate grievance The main grievance of the drivers is the imposition of higher fees for driving licences. a deep sense of grievance. a belief that you have been treated unfairly, or an unfair situation or event that affects and upsets you
A cause of uneasiness and complaint; a wrong done and suffered; that which gives ground for remonstrance or resistance, as arising from injustice, tyranny, etc
a claim by a teacher who has been evaluated that the results misrepresent the teacher's level of performance A grievance may lead to the filing of an appeal and possibly to a formal hearing See Appeal Process, Hearing
A request for reconsideration of a decision by MH/MR or the provider to deny authorization or payment for a service which was prescribed for the consumer
A tenant's right to seek a hearing from an objective person or panel concerning any public housing authority action or failure to act involving the tenant's base rent or housing authority regulations that adversely affect the individual tenant's rights, duties, welfare, or status