The Claims Process. 4.1. You shall provide to Us throughout the term of the Agreement all appropriate and available information relating to Your Claim as soon as possible. We will rely on all of the information that You provide as being true and accurate and You must promptly notify Us in writing should You become aware that any information You have provided is untrue, inaccurate or misleading in any way.
The Claims Process. 5.1. You agree to provide to Us throughout the term of the Agreement all appropriate and available information relating to your potential claim/Claim as soon as possible. The information that You provideshouldbetrueandaccuratetothebestofyourknowledgeandbelief.PleasenotethatifYou fail to provide Us with this information as described in this paragraph, you may impede our delivery of the Services to Youand Youmay become liable to Us for costs under paragraphs 7.1. and 7.2.
The Claims Process. What You Need to Do For all claims You must: • Take all necessary precautions to prevent further loss and/or damage to the Covered Item and preserve all parts of the Covered Item; • You must notify the Police in the event of any crime; • Lodge Your claim within 5 business days of the incident occurring, unless You are not reasonably able to do so, in which case You must lodge the claim as soon as practicable so that We can investigate the claim properly; • You must provide Us with all of the relevant information and documentary evidence that We may reasonably require including the Tax Invoice number; and • If We determine that the Cover applies to Your Covered Item, You will be required to pay the Excess applicable as outlined in these Terms and Conditions before We settle Your claim. For Theft claims You must: • Lodge a police report and provide Us a copy of it. We may also require further proof of loss such as photographs and repair receipts. • If the Covered Item is a Mobile Phone or a Tablet, contact Your voice and data telecommunications carrier as soon as possible to suspend the service and limit unauthorised usage (which includes requesting the carrier to suspend the use of Your SIM card which was used by the covered Mobile Phone or Tablet, and to block the IMEI number). You must provide Us with confirmation that Your SIM card has been suspended and the IMEI number has been blocked. For dual SIM devices both SIM cards are required to be suspended and both IMEI numbers need to be blocked. We may refuse to pay Your claim if You do not provide this confirmation. For all claims for Accidental Damage: • Upon notification of a claim being lodged, You must give Us an opportunity to assess and inspect the loss or damage to the Covered Item before We determine if it is a valid claim. • We will provide You with the pre-paid packaging to send the Covered Item to Our nearest authorised repair/replacement agent to have the damage assessed. It is Your responsibility to take the damaged Covered Item to a Post Office if requested by Us. • By sending the Covered Item to Our nearest authorised repair/replacement agent You agree that We may require the repair/replacement agent to dismantle it or authorise Us to dismantle it, so We can assess the claim and/or decide if it is valid. We may refuse to assess or pay the claim if You do not agree to this. • If We determine that the claimed damage is covered, We will settle the claim in accordance with the Terms and Conditio...
The Claims Process. A claim for accidental injury to natural teeth will be determined under Extended Health Care Plans with accidental dental coverage before it is considered under Dental Plans. • If the order of benefit payment cannot be determined from the above, the benefits payable under each Plan will be in proportion to the amount that would have been payable if Co-ordination of Benefits did not exist. • If the insured person is also covered under an individual travel insurance plan, benefits will be co-ordinated in accordance with the guidelines provided by the Canadian Life and Health Insurance Association. Submitting a Claim for Co-ordination of Benefits Submitting a Claim for Co-ordination of Benefits To submit a claim when Co-ordination of Benefits applies, refer to the following guidelines: • As per the Order of Benefit Payment section, determine which Plan is the Primary Carrier and which is the Secondary Carrier. • Submit all necessary claim forms and original receipts to the Primary Carrier. • Keep a photocopy of each receipt or ask the Primary Carrier to return the original receipts to you once your claim has been settled. • Once your claim has been settled by the Primary Carrier, you will receive a statement outlining how your claim has been handled. Submit this statement along with all necessary claim forms and receipts to the Secondary Carrier for further consideration of payment, if applicable.
The Claims Process. If the other Plan does not provide for Co-ordination of Benefits, it will be considered as the Primary Carrier, and will be responsible for making the initial payment toward the eligible expense. • If the other Plan does provide for Co-ordination of Benefits, the following rules are applied to determine which Plan is the Primary Carrier. – For Claims incurred by you or your Dependent Spouse: The Plan insuring you or your Dependent Spouse as an employee/member pays benefits before the Plan insuring you or your Spouse as a dependent. In situations where you or your Dependent Spouse have coverage as an employee/member under more than one Plan, the order of benefit payment will be determined as follows: ° The Plan where the person is covered as an active full-time employee, then ° The Plan where the person is covered as an active part-time employee, then ° The Plan where the person is covered as a retiree. – For Claims incurred by your Dependent Child: The Plan covering the parent whose birthday (month/day) is earlier in the calendar year pays benefits first. If both parents have the same birthdate, the Plan covering the parent whose first name begins with the earlier letter in the alphabet pays first. However, if you and your Spouse are separated or divorced, the following order applies: ° The Plan of the parent with custody of the child, then ° The Plan of the spouse of the parent with custody of the child (i.e., if the parent with custody of the child remarries or has a common-law spouse, the new spouse’s Plan will pay benefits for the Dependent Child), then ° The Plan of the parent not having custody of the child, then ° The Plan of the spouse of the parent not having custody of the child (i.e., if the parent without custody of the child remarries or has a common-law spouse, the new spouse’s Plan will pay benefits for the Dependent Child). • Where you and your spouse share joint custody of the child, the Plan covering the parent whose birthday (month/day) is earlier in the calendar year pays benefits first. If both parents have the same birthdate, the Plan covering the parent whose first name begins with the earlier letter in the alphabet pays first. Community Living Huronia 13
The Claims Process. The Claim
The Claims Process. How to Submit a Claim All claim forms, available from your employer, must be correctly completed, dated and signed. Remember, always provide your Group Policy Number, Plan Document Number and your Certificate number (found on your Group Benefit Card) to avoid any unnecessary delays in the processing of your claim. Your employer can assist you in properly completing the forms, and answer any questions you may have about the claims process and your Group Benefit Program.
