The highlighted language is a broad and material exception to the operation of Section 2.6. SelectCare is prohibited from denying a medically necessary claim under circumstances where good cause existed for the lack of prior authorization. This exception prevents SelectCare from unreasonably shifting the costs of its member’s medically necessary services to the Hospitals when the Hospital is not at fault. As discussed more fully below, good cause existed for the lack of authorization on each of the claims at issue. Accordingly, SelectCare’s denial of these medically necessary claims was unreasonable and payment should be made to the Hospitals.…
Question 5 The contract serves two primary purposes in nondisclosure and noncompetition. The agreement of employee noncompetition and nondisclosure only serves for the purpose of this contract. In this regard; provision 1(A), 7, 8, 11,12,13,14,15,16,17,18,19 are totally unrelated. Question 6…
In the case of Martin’s mountain property, there are two separate issues at play. The first issue that must be addressed is the bank’s foreclosure on the property due to Andrew’s default on his loan, and his decision to use Martin’s property as…
Furthermore, any modification made to the Articles required an…
Therefore the law requires us to apply for “Petition for Modification of…
The courts analysis considers the priority of claims between a mortgagee and a mechanic's lien dependent upon on the date the mortgage was reported and the date the mechanic's lien was reported. When a lien appellant's contract precedes the recording of the mortgage, the lien has priority over the mortgage. When the mortgage occurs before the mechanic's lien, the mechanic's lien is preferred only in part to the value of the improvements forming the basis for the lien. When sale proceeds are replaced in part for land and building, the mortgagee and lien claimant are entitled to the same interest in the sale earnings that they had in the property prior to its sale.…
In that case the formulation of the owner’s letter to the prospective buyer stated that the owner ‘may be prepared’ to sell the property to the prospective purchaser. The House of Lords ruled that the letter was not an offer, but rather, an invitation to treat. Lord Diplock observed that the relevant words in the owner’s letter were critical in coming to the conclusion that the letter was but a step in the negotiations for a contract which … never reached…
1. The DPP understands ST’s challenge to Document A ’s admissibility to be that they contend Document A falls within s 130(4)(f) to relate to “matters of state” for section 130(1) to apply. The DPP deny this. 2.…
There are several rights coming into question in Martin 's situation. The first thing in question is the rights of joint tenancy of his friend Peter. Usually, joint tenancy requires the share of the decided to be shared amongst the current owners, but this contract had the right of survivorship attached. Joint Tenacy causes a paradox where each member both own all and a part of the property (Orth, 2012, p.490), because of that the bank has every right to move to foreclose on the mountain property. However, Martin could claim that selling the property would cause injury to him, as he was not a co signor on the lease agreement and challenge the bank for sole ownership.…
Moreover, in section two, adding the first paragraph seems somewhat irrelevant and I would remove it, or edit it to make it clear that it means criminally. As mentioned before, I could have misunderstood that…
(Cole et al., 2014) These statues are defined as pre-set sentences…
Implied constructive trusts arise in the absence of a declaration of trust where another has acted to their detriment under the influence of the trustee which caused a mistaken belief that their act would lead to a beneficial interest in the land, similarly to proprietary estoppel in the necessity of acting to one’s detriment. Constructive trusts also aim to avoid unconscionable behaviour, the similarities in purpose between the two does create an expected amount of overlap. Claims in constructive trusts are governed by the Trust of Land and Appointment of Trustee’s Act 1996. Section 14 of the act gives the court the power to declare a person’s interest in property subject to trust. How a property can be owned differs, it can be in a person’s sole name, as tenants in common or as joint tenants and an expressed declaration of trust is a fundamental tool in the safe guarding the beneficial interest among parties.…
The cases have contrasting outcomes due mainly due to the language used by Manchester City Council which ended in Storer being able to buy the council house and Gibson being declined to buy the council house. In the Case of Gibson, Manchester City Council stated that they “may be prepared to sell the house”; whilst in the Storer case they stated that “if you will sign the Agreement and return to me, I will send you the Agreement sign on behalf of the Council in exchange”. The language and conduct of the Manchester City Council was objectively scrutinized in each case and found that there was intention to be bound in the Storer case however there was no intention to be bound in the Gibson case, Poole (2012). This can be applied in the scenario here, the language must be objectively scrutinized as this may affect whether Gary was issuing a counter-offer or a mere request for further information. This is critical as a counter offer voids the original offer in its entirety and therefore it would be determined that there is no valid contract between Gary and…
45), in American International Marine Agency of New York Inc v Dandridge [2005] Lloyd’s Rep IR 643, the slip policy contained a clause that provided “subject to the same clauses and conditions and against the same perils as in the original policy or policies”. A question that result from this was whether these words incorporated the leading underwriter clause in the binder. This raised a question of construction, but if the clause had not been incorporated, the decisive fact was that the leading underwriter clause was contained in the binder and not in the underlying policy. The words referring to the underlying policy were not extensive enough in their meaning to include a reference to the binder.…