Claims Administration. An employee will be required to comply with any and all rules and regulations and/or limitations established by the carrier or applicable third party administrator and contained in the policy, and employees and their dependents shall look solely to such carrier or third party administration for the adjudication of the payment of any and all benefits claims.
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 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 Trustees shall promptly proceed to implement the TDP.
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. 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. 1. Claims submitted pursuant to this settlement may be submitted, at the election of the Class member, by U.S. mail, email, or through the dedicated settlement website discussed below. The mailing address and email address to which Class members may submit Claims, as well as Class members’ right to submit their Claims through the settlement website, shall be posted prominently in each of the following locations: the Postcard Notice, Long Form Notice, the Informational Brochure (once prepared and as made available on the settlement website), the Claim Form, and the dedicated settlement website. The xxx.xxxxxxxxxx.xxx/xxxxxxxxx website shall provide a link to the dedicated settlement website.
2. The Claim Form shall provide an option for Class members to indicate a preference for communication via regular U.S. Mail. If Defendants have an email address for a Class member and the Class member did not indicate on the Claim Form that he or she prefers to communicate via regular U.S. Mail, Defendants shall respond by email. In instances in which U.S. Mail is used, HMA shall respond using the address provided on the corresponding Claim Form.
3. Upon receipt of a Claim, HMA shall review the Claim to determine whether the Claim meets all qualifications for payment set forth in this agreement and, if so, the amount owed.
4. Within 60 days of receiving a Claim, HMA shall provide written notice to the Class member who submitted it, notifying the Class member of:
A. the amount, if any, that Defendants propose to pay the Class member under this settlement;
B. the basis for HMA’s decision to pay less than all amounts claimed (if applicable); may:
C. the Class member’s right to attempt to cure any deficiency that led to the proposal to award less than full reimbursement; and
D. the Class member’s right to participate in alternative dispute resolution (if applicable).
5. In response to receiving the written notice under section III.4, Class members
a. Attempt to cure any deficiency stated as justification for not awarding all amounts claimed, by submitting the information and/or documentation identified by Defendants as lacking in the Claim, within 30 days of receipt of the written notice. Within 30 days of receiving such a cure attempt, Defendants shall provide written notice to the Class member stating the final determination as to the total amount to be paid to the Class member and the reasons for the amount if less than requested; or
b. Accept the compensation offered b...
Claims Administration. 7.1 The Claims Administrator shall administer and calculate the payments to Class Members.
7.2 No Person shall have any claim against the Claims Administrator, Xxxxxxx, the Released Parties, Xxxxxxx’x counsel, Settlement Class Counsel, Representative Plaintiff’s Counsel, and/or the Representative Plaintiff based on distribution of award payments to Settlement Class Members.
7.3 The Claims Administrator shall agree to hold the Settlement Fund in an interest- bearing qualified settlement fund account, and administer the Settlement Fund, subject to the continuing jurisdiction of the Court and from the earliest possible date, as a qualified settlement fund as defined by Treasury Regulation § 1.46B-1 et seq., and agree to any relation-back election required to treat the Settlement Fund as a qualified settlement fund from the earliest date possible. The Claims Administrator shall be responsible for filing tax returns and any other tax reporting for or in respect of the Settlement Fund and pay any taxes and tax-related expenses owed by the Settlement Fund out of the Settlement Fund. Except for funding the Settlement Fund, Xxxxxxx shall not have any other financial obligation under the Class Settlement Agreement. In addition, under no circumstances will Bassett have any liability for taxes or tax expenses under this Class Settlement Agreement. Funds may be placed in a non-interest-bearing account as may be reasonably necessary during the check clearing process. The Settlement Administrator shall provide an accounting of any and all funds in the Settlement Fund, including any interest accrued thereon and payments made pursuant to this Agreement, upon request of any of the Parties.
7.4 Taxes and Tax-Related Expenses relating to the Settlement Fund, if any, shall be considered Notice and Administrative Expenses and shall be timely paid by the Settlement Administrator out of the Settlement Fund without prior order of the Court. Further, the Settlement Fund shall indemnify and hold harmless the Parties and their counsel for Taxes and Tax-Related Expenses (including, without limitation, taxes payable by reason of any such indemnification payments). The Parties and their respective counsel have made no representation or warranty, and have no responsibility, with respect to the tax treatment by any Settlement Class Representative or any Settlement Class Member of any payment or transfer made pursuant to this Agreement or derived from or made pursuant to the Settlement Fun...
