Claims Administration Process. The fulfillment of the terms and conditions of this Policy (including payment of premium in full and on time) 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:
(1) 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.
(2) 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 or failure to follow such directions, Medical advice or guidance.
(3) If requested by Us and at Our cost, the Insured Person must submit to medical examination by Our Medical Practitioner as often as We consider reasonable and necessary and We/Our representatives must be permitted to inspect the medical and Hospitalisation records pertaining to the Insured Person’s treatment and to investigate the circumstances pertaining to the claim.
(4) We and Our representatives must be given all reasonable co-operation in investigating the claim in order to assess Our liability and quantum in respect of the claim.
Claims Administration Process. The fulfillment of the terms and conditions of this Policy (including payment of premium in full and on time) 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:
(1) 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.
(2) 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 or failure to follow such directions, Medical advice or guidance.
(3) If requested by Us and at Our cost, the Insured Person must submit to medical examination by Our Medical Practitioner as often as We consider reasonable and necessary and We/Our representatives must be permitted to inspect the medical and Hospitalisation records pertaining to the Insured Person’s treatment and to investigate the circumstances pertaining to the claim.
(4) We and Our representatives must be given all reasonable co-operation in investigating the claim in order to assess Our liability and quantum in respect of the claim.
I. Claims Procedure On the occurrence or the discovery of any Illness or Injury that may give rise to a claim under this Policy, then as a Condition Precedent to Our liability under the Policy the following procedure shall be complied with:
a. For Availing Cashless Facility
i. Cashless Facilities can be availed only at Our Network Providers.
ii. We reserve the right to modify, add or restrict any Network Provider for Cashless Facilities at Our sole discretion. Before availing Cashless Facilities, please check the applicable updated list of Network Providers.
b. Process for Obtaining Pre-Authorisation for Planned Treatment:
(i) We/TPA must be contacted to pre-authorise Cashless Facility for planned treatment at least 72 hours prior to the proposed treatment. Each request for pre- authorisation must be accompanied with all the following details:
(1) The health card which We or the associated TPA has issued to the Insured Person supported with the Insured Person’s KYC documents.
(2) The Policy number;
(3) Name of the Policyholder/Employer;
(4) Name and address of Insured Person/Employee/member in respect of whom the request is being made;
(5) Nature of the ...
Claims Administration Process. A. Pursuant to this Settlement Agreement, certain monetary benefits are available to eligible Class Members only upon submission of a timely and substantially compliant claim on a Claim Form approved by the Court. Court-approved Claim Forms shall be mailed together with the Notice, or otherwise made available through other means by the Claims Administrator, and shall have a return date of no earlier than ninety (90) calendar days from the date of the Class Notice Date. However, no Class Members who opted out of the Class shall be entitled to submit a Claim Form.
B. To the extent possible, the Settlement Administrator shall permit the return of Claims Forms by other means including, for example, fax, email, or online submission, and shall establish a process for return of Claims Forms by those other means if reasonably economical and practicable. In the event that alternative means for filing claims is permitted, such means will be explained in the class notice and on the Settlement Administrator’s website.
C. A copy of the Claim Form for which Court approval will be sought is attached hereto as Exhibit X.
Claims Administration Process. The Parties agree to cooperate in the administration of 3 the settlement and to make all reasonable efforts to control and minimize the costs and expenses incurred 4 in such administration.
Claims Administration Process. The Parties agree to cooperate in the administration of the 17 settlement and to make all reasonable efforts to control and minimize the costs and expenses incurred in 18 administration of the Settlement. The Claims Administrator will provide the following services: 19 44(a) Establish and maintain a Qualified Settlement Account. 20 44(b) Calculate the Individual Settlement Payment each Class Member is eligible to 21 receive. 22 44(c) Prepare and distribute emailed and mailed versions of the Class Notice. 23 44(d) Conduct additional address searches for mailed Class Notices that are returned as 24 undeliverable. 25 44(e) Process Claim Forms, Requests for Exclusion, calculate Participating Class 26 Members’ Individual Settlement Payment, field inquiries from Class Members, 27 and administer of any Requests for Exclusion. This service will include settlement 28 proceed calculation, printing and issuance of Settlement Payment Checks, and 1 preparation of IRS 1099 Tax Forms.
Claims Administration Process. The Parties agree to cooperate in the administration of the settlement and to make all reasonable efforts to control and minimize the costs and expenses incurred in administration of the Settlement. The Claims Administrator will provide the following services:
(a) Establish and maintain a Qualified Settlement Account. 40(b) Calculate the Individual Settlement Payment each Class Member is eligible to receive.
Claims Administration Process. 2 A. Pursuant to this Settlement Agreement, certain monetary benefits are available to 3 eligible Class Members only upon submission of a timely and substantially compliant claim on a 4 Claim Form approved by the Court. Court-approved Claim Forms shall be mailed together with the 5 Notice, or otherwise made available through other means by the Claims Administrator, and shall 6 have a return date of no earlier than ninety (90) calendar days from the date of the Class Notice 7 Date. However, no Class Members who opted out of the Class shall be entitled to submit a Claim 8 Form.
9 B. To the extent possible, the Settlement Administrator shall permit the return of Claims 10 Forms by other means including, for example, fax, email, or online submission, and shall establish a 11 process for return of Claims Forms by those other means if reasonably economical and practicable.
Claims Administration Process. Claim Forms must be mailed to the Settlement Administrator at the address indicated in the Class Action Settlement Notice, and postmarked no later than forty-five (45) days from the Notice Date. Claim Forms that are timely mailed to the correct address shall be processed as follows:
1. Within thirty (30) days after the deadline to submit Claim Forms, the Settlement Administrator shall, in consultation with the Parties: (a) make a determination of the payment, if any, due in response to each Claim Form timely mailed to the correct address; and, (b) give written notice of each such determination to Class Counsel and Counsel for the Defendants. The Settlement Administrator and Defendants may make a determination of the payment, if any, due in response to a particular claim based in whole or in part on any deficiency in the information provided in the Claim Form, and shall provide written notice of each such determination to Class Counsel. If the Settlement Administrator identifies any such deficiency, it shall notify the Class Member in order to provide the opportunity, pursuant to Paragraph VII.B.2., below, to correct the deficiency.
2. A Settlement Class Member who receives a determination of a deficiency shall have twenty (20) days after the date that the Settlement Administrator mails the determination to cure any deficiencies noted and provide written proof to the Settlement Administrator of the cure of all deficiencies.
3. Thereafter, within twenty (20) days of receipt by the Settlement Administrator of such written notice of the cure of deficiencies by the Settlement Class Member, the Settlement Administrator, in consultation with the Parties, shall either approve the claim for refund or notify the Settlement Class Member and Class Counsel of Final Rejection of Claim. Any dispute on this Final Rejection must be submitted to the Court by the Settlement Class Member, for final resolution pursuant to Paragraph IX., within twenty (20) days after the date on which the Settlement Administrator mailed the Notice of Final Rejection of Claim.
4. Notwithstanding anything to the contrary, Claim Forms that are not timely mailed to the appropriate address for the Settlement Administrator will not be considered for payment and the individual Settlement Class Member will be provided written notice thereof. Untimely-filed Claim Forms shall not be subject to any appeal process.
5. All returned Class Action Settlement Notices, Claim Forms, and correspondence relating th...
Claims Administration Process. Settlement Class Members who submit Valid Claims by the claims filing deadline described on the settlement website (“Claims Deadline”) are “Authorized Claimants.” Subject to Court approval, each Authorized Claimant shall be entitled to receive a Settlement Payment. Described below are the administrative procedures that will apply to determine eligibility.
(a) The Settlement Administrator shall establish a designated page of the Settlement Website on which the Claim Form may be completed and submitted electronically, and which will permit a click through electronic signature. An electronic receipt and confirmation number shall be displayed following the electronic completion of the Claim Form. A Claim Form submitted electronically through the Settlement Website shall be considered complete when each item of information requested in the Claim Form has been completed and an electronic receipt displayed. A Claim Form submitted other than through the Settlement Website shall be considered complete when each item of information requested in the Claim Form is entered in writing and the Claim Form is timely postmarked or delivered to the Settlement Administrator before the expiration of the Claims Period. Each Settlement Class Member wishing to receive a Settlement Payment must submit a Claim Form that provides their name, their email address (if any), and any unique claimant ID code and/or other information required by the Settlement Administrator to confirm that the individual requesting the Settlement Payment is a Settlement Class Member. In addition, a Claim Form shall not be complete unless the Settlement Class Member provides their mailing address and selects whether to receive their Settlement Payment in the form of a paper check, or an electronic debit or gift card (electronic debit or gift cards are “Electronic Payments.”)
(b) The Settlement Administrator shall implement procedures to review each Claim Form submitted to determine whether the submission is a Valid Claim. The Settlement Administrator shall make this determination by confirming that the information provided in the Claim Form matches the business records to be provided by Settling Defendant identifying the members of the Settlement Class and any additional validation information (such as a unique claimant ID code) utilized by the Settlement Administrator for purposes of preventing fraudulent submissions. Claim Forms submitted by persons who are not Settling Class Members shall be rejected.
(c...
Claims Administration Process. Each Settlement Class Member shall have the opportunity to participate in the Claims Administration Process. All Settlement Class Members applying for Monetary Awards must submit Claim Forms to the Claims Administrators in accordance with the Claims Administration Process, this Settlement Agreement, and the Allocation Agreement.
