Claims Administration Clause Samples

Claims Administration. The Claims Administrator shall, subject to the supervision of the Court, administer the relief provided by this Settlement Agreement by processing Claim Forms in a cost effective and timely manner. The Claims Administrator shall maintain reasonably detailed records of its activities under this Settlement Agreement. The Claims Administrator shall maintain all such records as are required by applicable law in accordance with its normal business practices and such records will be made available to Class Counsel and the GEICO COMPANIES’ Counsel promptly upon request. The Claims Administrator shall also provide reports and other information to the Court as the Court may require. The Claims Administrator shall promptly upon request provide Class Counsel and the GEICO COMPANIES’ Counsel with information concerning Notice, administration and implementation of the Settlement Agreement. Should the Court request or should it be reasonably advisable to do so, the Parties, in conjunction with the Claims Administrator, shall submit a timely report to the Court summarizing the work performed by the Claims Administrator. Without limiting the foregoing, the Claims Administrator shall: a) promptly forward upon request to the GEICO COMPANIES’ Counsel and Class Counsel copies of all documents and other materials relating to the administration of the Settlement Agreement; b) receive Opt-Out Requests from Settlement Class Members and promptly provide to Class Counsel and the GEICO COMPANIES’ Counsel a copy thereof upon receipt. If the Claims Administrator receives any Opt-Out Requests from Settlement Class Members after the Opt-Out Deadline, the Claims Administrator shall promptly provide copies thereof to Class Counsel and the GEICO COMPANIES’ Counsel; c) provide reports and summaries, as requested, to Class Counsel and the GEICO COMPANIES’ Counsel, including without limitation reports regarding the number of Claim Forms received and the identity of the Settlement Class Members; d) employ reasonable procedures to screen Claims Forms for fraud, and shall reject a Claim Form, or any part of a claim for a payment reflected therein, where the Claims Administrator determines that there is evidence of fraud. The Claims Administrator will review each Claim Form based upon the initial submission by Settlement Class Members and ensure that each is complete; e) prepare a declaration attesting to compliance with the Class Notice requirements set forth in this Agreement and identifying al...

Claims Administration. The Service Provider shall administer claims on the Reinsured Policies as appropriate, including the following: (a) Reviewing and paying all claims for benefits which the Service Provider's review determines to be qualified for payment in accordance with applicable Reinsured Policy provisions. Any such payments shall be made within the time periods and in the manner prescribed by Applicable Law. Each payment made by the Service Provider with respect to claims subject to this Agreement shall, where appropriate, be made in full and final discharge of the obligations of the Company or the Service Provider under the applicable Reinsured Policy with respect to such payment; (b) Reviewing and (subject to Section 6.03 of this Agreement) compromising or denying, as is appropriate based on the guidelines of the Company in effect immediately prior to the Effective Date, all claims for benefits which the Service Provider's review determines to be qualified for such denial or compromise, in reliance on applicable Reinsured Policy provisions. In the event of non-payment of claims on account of incomplete or insufficient data, the Service Provider shall acknowledge such fact to the claimant by the earlier of (i) ten (10) Business Days from date of receipt of the claim or (ii) the number of days provided by Applicable Law; (c) Communicating with claimants with respect to the submission, approval and payment, compromise or denial of claims made under the Reinsured Policies; (d) Maintaining such files and records as are necessary to enable the Company, at any time, to determine the true and accurate claim experience on the Reinsured Policies; (e) Conforming to the reasonable requirements set by the Company for monthly submission of claims reports; (f) Performing such other claim services as may be reasonably required in connection with the support and administration of the Reinsured Policies; (g) Preparing all Federal Tax reports and state tax reports required by Applicable Law, including without limitation 1099-R, 1099-INT, 1099MISC, W-2P, W-2 and 5498 for policyholders and beneficiaries as required, and distributing the same to policyholders and beneficiaries and appropriate authorities; (h) Responding to any requests from plan administrators or trustees for policy information affecting the plan or participants for qualified plans; (i) Responding to requests for calculations applicable to annuity payments as may be necessary for Tax calculations; (j) Responding to reques...

Claims Administration. The fulfillment of the terms and conditions of this Policy (including payment of premium by the due dates mentioned in the Policy Schedule / Certificate of Insurance) 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. Claims shall be settled by Us, On the occurrence or discovery of any event 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, We may conduct Medical examination by any Medical Practitioner for this purpose when and so often as We may reasonably require. 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;

Claims Administration the processing of claims made under the Insurance Policies, including the reporting of claims to the insurance carrier, management and defense of claims and providing for appropriate releases upon settlement of claims.

Claims Administration. The Trustees shall promptly proceed to implement the TDP.

Claims Administration. 7.1 The Claims Administrator shall administer and calculate the Settlement Claims submitted by Settlement Class Members. All Settlement Claims must be submitted on or before the Claims Deadline to be deemed timely. The determination by the Claims Administrator of the validity or invalidity of all Settlement Claims shall be binding. The Claims Administrator shall periodically provide Settlement Class Counsel and CaptureRx counsel with reports as to both settlement claims and distribution, and they shall have the right to obtain and review supporting documentation and challenge such reports if they believe them to be inaccurate or inadequate. 7.2 For each settlement claim submitted and received, the Claims Administrator, in its sole discretion (to be reasonably exercised), will determine whether: (1) the claimant is a Settlement Class Member and, if applicable, and California Settlement Subclass Member; and (2) that the claimant has provided all information required to complete the Claim Form by the Claims Deadline, including but not limited to information required under Paragraph 2. The Claims Administrator may, at any time, request from the claimant, in writing, additional information as the Claims Administrator may reasonably require in order to adequately evaluate the settlement claim. All information provided to the Claims Administrator will be deemed confidential by the Claims Administrator. 7.3 The Claims Administrator shall determine whether a claimant’s Claim Form, along with supporting materials, are sufficient to support a claim. If the Claims Administrator should receive an incomplete Claim Form or a Claim Form with insufficient documentation to determine whether the claimant is a Settlement Class Member or, if applicable, a California Settlement Subclass member, the Claims Administrator shall request additional information and give the claimant twenty-one (21) days to cure any defect(s) before rejecting a settlement claim. The Claims Administrator shall make requests for additional information within twenty-one (21) days after the Claims Deadline. If a Settlement Class Member fails to correct all deficiencies within twenty-one

Claims Administration. HEBP shall administer claims as provided in this Agreement. HEBP is empowered by the Plan Administrator to do all things it deems necessary to carry out the terms and purposes of Member’s Plan only as expressly stated in this Agreement or as mutually agreed to in writing between the parties hereto. HEBP has discretion, subject to Member’s final authority, to determine whether claims are payable under the Member’s Plan.

Claims Administration. The Company shall have ultimate responsibility for claims adjustments and payments. The Manager will receive all claims and notice of claims from policyholders of the Company. The Manager will review, process, investigate, adjust, settle or resist all claims received in accordance with the Company's direction, the terms of Company coverage documents, and any written guidelines or decision of the Company regarding coverage, handling or payment of claims. The Manager will establish loss reserves for each claim as deemed necessary in accordance with the Company's direction. The Manager will make subrogation investigations and consult with the Company or its representatives for the proper adjusting of subrogation matters. The Manager will engage attorneys as necessary, to represent policyholders in any suit covered by the Company's policy.

Claims Administration. 4.1 The Claims Administrator shall administer the process of notifying the Settlement Class; receiving, processing and paying claims, Settlement Class Counsel’s approved attorneys’ fees and costs, and the Settlement Class Representative’s approved service award; opening and maintaining bank accounts and maintaining the Gross Settlement Amount and Net Settlement Fund; complying with all tax-reporting obligations such as issuing and mailing to Settlement Class Members any necessary United States Internal Revenue Service 1099 Forms; obtaining any necessary information from Settlement Class Counsel, the Settlement Class Representative and Authorized Claimants for tax reporting purposes; and carrying out any other duties necessary to administer the Class Action Settlement and/or to which the Parties otherwise agree in writing. The Claims Administrator shall ensure that the information that it receives from the Parties, their Counsel and/or Settlement Class Members is secured and managed in such a way as to protect the security and confidentiality of that information from third parties. 4.2 The Claims Administrator shall provide a declaration to Settlement Class Counsel and Defense Counsel confirming that the Claims Administrator provided the Settlement Class with notice in accordance with the Court’s preliminary approval order and any subsequent orders the Court might make as to the notice to be provided the Settlement Class, along with a list of all Settlement Class Members who submitted timely and valid requests for exclusion, as described in Section 10 of this Agreement.