Party

If a case involves the Americans with Disabilities Act (ADA) case where the Department of Justice (DOJ) is a party or has submitted an amicus brief goes to trial or is appealed, a court may issue a decision on the merits of the case. These court decisions have the force of law.

An appeals court can only reverse the decision of a lower court if it finds that the lower court judge made an error. An appeals course will reverse an error that is prejudicial to a party, but will generally not reverse a "harmless" error that does not affect the outcome of the case.

A review of a plan's decision to deny coverage for or payment of a service by an independent third-party not related to the plan. If the plan denies an appeal, an external review can be requested. In urgent situations, an external review may be requested even if the internal appeals process isn't yet completed. External review is available when the plan denies treatment based on medical necessity, appropriateness, health care setting, level of care, or effectiveness of a covered benefit, when the plan determines that the care is experimental and/or investigational, or for rescissions of coverage. An external review either upholds the plan's decision or overturns all or some of the plan’s decision. The plan must accept this decision.

When a third party holds an informal meeting with both sides in a dispute to promote resolution of a grievance, a compromise, or a settlement of a lawsuit. The result of the mediation, if any, is not binding on the parties. A mediator can be court-appointed or chosen by the parties.

A reimbursement system that protects insurers from very high claims. It usually involves a third party paying part of an insurance company’s claims once they pass a certain amount. Reinsurance is a way to stabilize an insurance market and make coverage more available and affordable.