Claim Administration. The fulfillment of the terms and conditions of this Policy (including payment of premium by the due dates mentioned in the Policy Schedule) insofar as they relate to anything to be done or complied with by You or any Insured Person, including complying with the following in relation to claims, shall be conditions precedent to admission of Our liability under this Policy:
(a) On the occurrence or discovery of any Illness or Injury that may give rise to a Claim under this Policy, the Claims Procedure set out below shall be followed;
(b) The directions, advice and guidance of the treating Medical Practitioner shall be strictly followed. We shall not be obliged to make any payments that are brought about or contributed to as a consequence of intentional/ deliberate failure to follow such directions, advice or guidance;
(c) If requested by Us and at Our cost, the Insured Person must submit to medical examination by Our nominated Medical Practitioner as often as We consider reasonable and necessary and We/Our representatives must be permitted to inspect the medical and Hospitalization records pertaining to the Insured Person’s treatment and to investigate the facts surrounding the Claim. Such medical examination will be carried out only in case of reimbursement claims with prior consent of the Insured Person;
(d) We/Our representatives must be given all reasonable co-operation in investigating the claim in order to assess Our liability and quantum in respect of such Claim;
(e) If the Insured Person suffers a relapse within 45 days of the date of discharge from Hospital for a Claim that has been made, then such relapse shall be deemed to be part of the same Claim and all limits for Any One Illness under this Policy shall be applied as if they were part of a single claim.
Claim Administration. The Fund has sole authority in all claim decisions, including the extent to which any coverage or limit applies. The Covered Person retains all rights afforded by law.
Claim Administration. IMS shall provide Claims administration in accordance with the Arrangement, the Financial Control Plan and the Agreement, which claim administration processing services are outlined below. Any litigation costs not reimbursed by FEMA would be the responsibility of the Customer. IMS may also rely on the information and direction contained in the WYO Flood Program Claims Manual, the FEMA Adjuster Manual, the Flood Insurance Agent's Manual, the Standard Flood Insurance Policy, the WYO Operational Overview, and/or other WYO Flood Program instructional material.
a) Claim Management Facilitation. - Twenty-four (24) hour reporting capability, first notice of loss, coverage for verification and WYO Policy claim; - Investigation of WYO Policy claim; - Fast track unit; - Reinspection and audit; - Claims handling standards/best practices; - Claim check issuance; - Management reports; - WYO Policyholder satisfaction surveys; - Special Investigation Unit ("SIU") services; - Salvage & subrogation claim processing; - Litigation support.
Claim Administration. 13.2.1 If the Buyer receives a written claim or a suit is threatened or commenced against the Buyer for infringement, the Buyer shall:
(i) forthwith notify the Seller giving particulars thereof;
(ii) furnish to the Seller all data papers and records within the Buyer’s knowledge control or possession;
(iii) refrain from admitting any liability or making any payment or assuming any expenses, damages, costs or royalties or otherwise acting in a manner prejudicial to the defence or denial of such suit or claim;
(iv) fully cooperate with, and render all such assistance to, the Seller as may be pertinent to the defence or denial of the suit or claim;
(v) act in such a way as to mitigate damages and / or to reduce the amount of royalties which may be payable as well as to minimize costs and expenses.
13.2.2 The Seller shall be entitled either in its own name or on behalf of the Buyer to conduct negotiations with the party or parties alleging infringement and shall assume and conduct the defence or settlement of any suit or claim in the manner which it, in its opinion, deems proper and does not prejudice the Buyer.
Claim Administration. CompCare shall arrange for the processing of claims submitted for MHSA Services. CompCare shall arrange for CompCare Providers to submit claims for MHSA Services to the Claims Administrator, which may be CompCare. Claims shall be paid in accordance with Applicable Law as well as the terms and conditions of the Benefit Plan and this Agreement and, with respect to CompCare Providers, the agreements with the CompCare Providers.
Claim Administration. Upon determination of a potential claim under the Policy, you will confirm employees’ eligibility for coverage and provide required eligibility and claim documentation to the Company, either directly or through your health claim administrator. The Company shall be responsible for all claim reviews, determinations and payments under the Policy.
Claim Administration. 1. Upon receiving a timely Claim for Reimbursement, the Claim Administrator shall review the documentation accurately and in good faith in accordance with the terms and conditions of this Settlement Agreement. The Claim Administrator shall also use all reasonable efforts and means to identify and reject duplicate and/or fraudulent claims, including, without limitation, maintaining a record of every payment made to a Class Member.
2. The Claim Administrator shall communicate with both Parties simultaneously with respect to any questions it may have regarding the Settlement terms and/or any particular claims.
3. Only timely Claims that are complete and satisfy the Settlement criteria for reimbursement (including timely submitted claims whose deficiencies are cured in a timely fashion) can be approved for payment. For each approved reimbursement claim, the Claim Administrator, on behalf of Defendant, shall mail to the Settlement Class Member, at the address listed on the Claim Form, a reimbursement check to be sent within one-hundred (100) days of the date of receipt of the complete Claim with all required documents and proof, or within one-hundred (100) days of the Effective Date, whichever is later. Reimbursement checks for approved Claims shall remain valid for one-hundred eighty (180) days. The Settlement Class Member may make one (1) request for reissuance of an expired un-negotiated reimbursement check from the Claim Administrator within two hundred and seventy-five (275) days of its original issuance.
Claim Administration. 1) Claim Management and Administration. In compliance with its Best Practices, CCMSI will manage and administer all claims of the Client that occur during the period of this Agreement. All claim payments shall be made with Client funds. CCMSI will act on behalf of Client in handling, monitoring, investigating, overseeing and adjusting all such actual and alleged claims.
2) Claim Settlement. CCMSI will settle claims of the Client with Client funds in accordance with reasonable limits and guidelines established with the Client.
3) Claim Reserves. CCMSI will recommend reserves for unpaid reported claims and unpaid claim expenses.
4) Allocated Claim Expenses. CCMSI will pay all Allocated Claim Expenses with Client Funds. Allocated Claim Expenses are charges for services provided in connection with specific claims by persons or firms which are eligible claim expenses under the Client’s program. Notwithstanding the foregoing, Allocated Claim Expenses will include all expenses incurred in connection with the investigation, adjustment, settlement or defense of Client claims, even if such expenses are incurred by CCMSI. Allocated Claim Expenses will include, but not be limited to, charges for:
(a) Independent medical examinations of claimants;
(b) Managed care expenses, which include the services provided by comp mc™, CCMSI’s proprietary managed care program. Examples of managed care expenses includes but is not limited to PPO net works, utilization review, nurse case management, medical xxxx audits and medical xxxx review;
(c) Fraud detection expenses, such as surveillance, which include the services provided by fire, CCMSI’s proprietary Special Investigation Unit (SIU), and other related expenses associated with the detection, reporting and prosecution of fraudulent claims, including legal fees;
(d) Attorneys, experts and special process servers;
(e) Court costs, fees, interest and expenses;
(f) Depositions, court reporters and recorded statements;
(g) Independent adjusters and appraisers;
(h) Index bureau and OFAC (Office of Foreign Assets Control) charges;
(i) MMSEA/SCHIP compliance charges;
(j) Electronic Data Interchanges, EDI, charges if required by State law;
(k) CMSI personnel, at their customary rate or charge, but only with respect to claims outside the State and only if such customary rate is communicated to the Client prior to incurring such cost;
(l) Actual reasonable expenses incurred by CCMSI employees outside the State for meals, travel, and lodgin...
Claim Administration. IMS shall provide Claims administration in accordance with the Arrangement, the Financial Control Plan and the Agreement, which claim administration processing services are outlined below. Any litigation costs not reimbursed by FEMA would be the responsibility of the Customer. IMS may also rely on the information and direction contained in the WYO Flood Program Claims Manual, the FEMA Adjuster Manual, the Flood Insurance Agent's Manual, the Standard Flood Insurance Policy, the WYO Operational Overview, and/or other WYO Flood Program instructional material.
a) Claim Management Facilitation. - Investigation of WYO Policy claim; - Fast track unit; - Reinspection and audit; - Claims handling standards/best practices; - Claim check issuance; - Management reports; - WYO Policyholder satisfaction surveys; - Special Investigation Unit ("SIU") services; - Salvage & subrogation claim processing; - Litigation support.
Claim Administration. The Reinsurer will accept the decision of the Ceding Company with respect to payment of Claims. The Ceding Company is responsible for the settlement of Claims in accordance with applicable law or regulation and the Rider terms. The Ceding Company will reimburse the Reinsurer for its proportionate share of any recovered overpayment of Claims. Reimbursement shall be made as part of the settlement for the Accounting Period during which the overpayment was recovered.
