Eligibility criteria encompass product use verification, injury qualification, exposure period, limitations compliance, and any exclusions such as alternative causes or prior settlements. They govern the claims administrator's determinations.
Criteria typically include a documentation standard for each element.
Alternative Names:
Settlement Eligibility, Qualification Criteria
Why it Matters?
Precision in drafting is what prevents administration disputes, since ambiguous criteria produce appeals that consume time and cost. Each element needs a defined documentation standard specifying what proof suffices, because an administrator applying judgment rather than a standard produces inconsistent outcomes. Building an appeals process with a neutral decision-maker is the necessary complement, since some disputes are unavoidable.
Frequently Confused with
Related terms
Frequently asked questions
What should eligibility criteria specify?
Why is an appeals process necessary?
