TN 3 (03-95)

GN 03960.080 Model Interim Letters - Administrative Review - Fee Agreement Process

A. POLICY

The following subsection provides models of the interim letters described in GN 03960.035B.5. and GN 03960.055C.8. Dictated letters should be prepared using these model letters as guides.

B. EXHIBITS

Letter AR-7

Interim Letter - Good Cause Development - To Nonrequester

Letter AR-8

Interim Letter - Good Cause Found - To Requester

Letter AR-9

Interim Letter - Good Cause Found - To Nonrequester

Letter AR-10

Interim Letter - Requesting Information on Services and Time Spent - To Representative

Letter AR-11

Interim Letter - Requesting Information on Services and Time Spent - To Other Party

 

AR-7 Interim Letter - Good Cause Development - To Nonrequester

Marvin Levy
Attorney at Law
Street Address
City/State/Zip Code

We are writing to you about Bruce Smith's request to review the fee amount we said you can charge for your work on his claim. In our letter dated August 3, 1995, we said that we sent Mr. Smith a letter asking why he did not ask for review on time.

What You Can Do

Address of Originating Component

  • We are sending you a copy of Mr. Smith's letter giving us his reasons. If you have comments about the letter, 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:

     

If You Have Any Questions

  • See Referral Paragraphs in Model Acknowledgment Letter AR-2

AR-8 Interim Letter - Good Cause Found - To Requester

Bruce 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 15 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 Marvin Levy, Susy Smith, Joey Smith, and James Kelly (claims representative) can comment on your request for administrative review, 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 AR-1

AR-9 Interim Letter - Good Cause Found - To Nonrequester

Susy Smith
Street Address
City/State/Zip Code

We told you before that we sent Bruce Smith a letter asking why he did not ask for review of his lawyer's fee within 15 days. He gave us his reasons for not filing on time.

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

Address of Originating Component

  • 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:

     

If You Have Any Questions

  • See Referral Paragraphs in Model Acknowledgment Letter AR-2

AR-10 Interim Letter - Requesting Information on Services and Time Spent - To Representative

Jane Doe
Attorney at Law
Street Address
City/State/ZIP Code

We are writing about your request to review our decision on the fee agreement between you and Sally Brown.

If we cannot decide the