BASIC (03-95)

GN 03950.060 Model Interim Letters - Administrative Review - Fee Petition Process

A. POLICY

The following subsection provides models of the interim letters described in GN 03950.030. Dictated letters must be prepared using these model letters as guides.

B. EXHIBITS

Letter AF-5Interim Letter - Good Cause Development
(To Nonrequester)
Letter AF-6Interim Letter - Good Cause Found
(To Requester)
Letter AF-7Interim Letter - Good Cause Found
(To Nonrequester)

 

AF-5 — Interim Letter - Good Cause Development (To Nonrequester)

 

Susy Smith
Street Address
City/State/ZIP Code

 

James Smith asked us to review the fee amount his representative can charge for his work on Mr. Smith's claim. We told you before that we sent Mr. Smith a letter asking why he did not ask for review of the representative's fee within 30 days. He gave us his reasons for not filing on time.

 

What You Can Do

 

Since you can comment on his reasons, we are sending you a copy of his letter. If you have comments or want to give us more information, write us within 15 days.

 

Address of Originating Component

 

If You Have Any Questions

 

See Referral Paragraphs in Model Acknowledgment Letter AF-3

 

AF-6 — Interim Letter - Good Cause Found (To Requester)

 

James Smith
Street Address
City/State/ZIP Code

 

On June 25, 1995, you asked us to lower the fee amount we said your lawyer can charge for his work on your claim. You said that you had a good reason for not asking us to review our decision within 30 days of the date of our letter. You said that you were in the hospital until June 20, 1995.

 

Our Decision About The Late Request

 

We decided that you had a good reason for not asking for a review on time. So, we will review our decision.

 

What Will Happen

 

Someone who did not decide the fee amount will review the decision and make a new one. Based on that review we will raise, lower, or not change the fee amount your lawyer can charge.

 

Because John Jones, Susy Smith, and Joey Smith can comment on your request for administrative review. So, we are sending them a copy of your letter. They also can provide more information to the person reviewing your request.

 

If we need more information, we will contact you. We will send you and the other people listed above a letter telling what we decide.

 

If You Have Any Questions

 

See Referral Paragraphs in Model Acknowledgment Letter AF-1

 

AF-7 — Interim Letter - Good Cause Found (To Nonrequester)

 

Susy Smith
Street Address
City/State/ZIP Code

 

We told you before that we sent James Smith a letter asking why he did not ask for review of his representative's fee within 30 days. He gave us his reasons for not filing on time.

 

Our Decision About The Late Request

 

We have decided that he had a good reason for not asking for a review on time. So we will review our decision.

 

What Will Happen

 

Someone who did not decide the fee amount will review the decision and make a new one. Based on that review we will raise, lower, or not change the fee amount the lawyer can charge.

 

What You Can Do

 

You can comment on Mr. Smith's request for review of the fee amount. You can also provide more information to the person reviewing the request. If you have comments about the request for review, or want to give us more information, write us within 15 days. We will consider what you tell us. You can write us at this address:

 

Address of Originating Component

 

If You Have Any Questions

 

See Referral Paragraphs in Model Acknowledgment Letter AF-3