Appeals

FloridaJen

The Curious One
Joined
Nov 19, 2015
Messages
174
Location
Florida
Is it a good or bad sign if the appeals department can’t find the exclusion in the contract that they say is the reason for the denial for the DS and then says she reviewed the “what’s covered” and “what’s not covered” section and “it’s confusing”, so she’s forwarding to member services.

Anyone know? :rolleyes:
 
Well, it’s not bad. Ambiguous terms in a contract of adhesion (one party is the drafter and the other party has no ability to negotiate the terms of the contract) are construed against the drafter.
 

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