Claims Administration Services Sample Clauses

Claims Administration Services. If claims services are to be provided pursuant to a particular Service Addendum, then, unless otherwise specifically noted in such Service Addendum, that Service Addendum will be deemed to require the claims administration services set forth in this subsection. Specifically, INSpire will: (i) Investigate, evaluate, and handle each claim reported according to applicable state law, the terms and conditions of the policy and any written standards provided by Customer using appropriately trained and licensed personnel. Customer grants INSpire the authority to provide the foregoing claims administration services; provided, however that INSpire will not have any authority to alter or discharge any policy or waive any policy provision or condition. (ii) establish a claims operation center that will function as a control unit; (iii) verify coverage on all cases; (iv) administer the appraisal/assessment process using a combination of staff, independent appraisers and direct repair facilities reasonably acceptable to Customer; (v) perform all reasonable and necessary administrative and clerical work in connection with claim or loss reports; (vi) establish and maintain a claim file for each reported claim or loss. The claim file will have a daily activity log, which will be available for review at any and all reasonable times by Customer subject to the provisions of the Agreement; (vii) record and report each claim promptly to Customer with a recommended reserve; and will consult with, and seek consent from, Customer with respect to any of the following: (A) any loss or claim resulting in legal action being instituted against Customer's insured, INSpire or Customer; (B) any loss or claim causing a complaint to be filed with any regulatory authority; (C) any inquiry from any regulatory authority, including but not limited to any insurance department, with respect to any claim or claims, even if no complaint causes such inquiry; (D) any claim in which INSpire deems appropriate to rescind policy coverage for material misrepresentation; (E) any claim involving an allegation of extra contractual obligations, or bad faith claim handling; (F) any claim involving a fatality, major amputation, spinal cord or brain damage, loss of eyesight, extensive burns, poisoning or multiple fractures; (G) any claim that Customer desires to be kept advised of during the life of the claim; or (H) any claim where there has been a demand for policy limits and INSpire does not evaluate the val...
Sample 1
Claims Administration Services. Claims administration fees for each of the months during the Initial Period will be equal to 6.67% of the Earned Premium recognized by Customer for such month, subject to a minimum monthly claims administration fee of $111,167. Claims administration fees for each month subsequent to the Initial Period will be equal to 6.50% of the Earned Premium recognized by Customer for each such month, subject to a minimum monthly claims administration fee of $108,333. Effective January 1, 2000, the claim administration fee will be 7.0% of the earned premium subject to a minimum of $105,000.
Sample 1
Claims Administration Services. Active management of new and legacy claims.
Sample 1
Claims Administration Services. Prior to January 1, 2000 for all programs and January 1, 2000 and later for any discontinued programs, fees will be based on a charge per claim as defined below. A claim is defined as an open feature as shown below. Monthly maintenance fees are for claims open greater than 31 days at each month end. Customer will not be responsible for any of the fees set forth below that are incurred in connection with a claim opened in error. Feature Claim Fee Monthly Fee Auto BI/UM $450 $100 Auto Non-BI/UM $250 $50 Auto First Party $150 $50 Homeowners $600 $60 Commercial Property $700 $70 Commercial Casualty $1,000 $100 Effective January 1, 2000, all programs other than discontinued programs will be charged at the following rates: Line of Business Percent of Earned Premium Residential Property 7.0% Personal Auto 7.5% Commercial Lines 9.5% Other Fees: ---------- Subrogation 25% of recoveries Salvage 15% of recoveries SIU Services $60.00/hr. plus outside fees Homeowner, Commercial Property and Commercial Casualty claims with an incurred loss greater than $100,000 will be billed at "time and expense," rather than the rates shown on the above schedule. "Time and expense" is defined as $60.00 per hour plus any outside adjusting fees.
Sample 1
Claims Administration Services. Claims Administration fees shall be equal to 7.75% of the Earned Premium recognized by the Client for each month. Subject to Section 7.2(d) of the Processing Services Agreement to which this Schedule 1 is a part, CGI will be entitled to retain 25% of all subrogation recoveries and 15% of all salvage recoveries. Special Investigative Unit Services will be provided as approved by Client for the fee of $60 per hour, plus actual expenses.
Sample 1
Claims Administration Services. On or before the first day of each month during the Term, the Town will pay Consultant a fixed monthly fee for the claims administration services described in this Agreement. The Town's obligation to pay compensation in future fiscal years shall be contingent upon budget authorization by the Town Council. $4,291.66 monthly FY 2017-18
Sample 1
Claims Administration Services. Effective January 1, 2000, the claim administration fee will be 7.0% of the Earned Premium recognized by Customer subject to a minimum of $105,000.00 until August 31, 2001 when the minimum monthly fee shall be completely eliminated and no minimum shall be required thereafter.
Sample 1
Claims Administration Services. Servicing Company will handle all self-insured workers compensation claims reported to it by Client during and for the term of this Agreement, or any extension thereof, consistent with the terms of this Agreement and the workers’ compensation laws, rules and regulations of the State of South Dakota. Claims administration services consist of: a. Conduct a claims investigation as appropriate for each loss in order to establish compensability. In the course of conducting a claims investigation, the services of independent contractors may be retained and paid from the loss fund account as an allocated loss adjustment expense including independent adjustment companies, managed care providers, medical specialists and legal service providers as necessary to determine claim compensability or otherwise assist in properly resolving such claims. Investigations using outside field adjusters may be performed, at the discretion of the claim examiner. 2014 SI ASA b. Establish individual claim files for each reported claim. Claim files shall be subject to review, copying and printing by Client, its representative or designee, at any reasonable time within normal business hours upon reasonable notice. c. Xxxxxx, or contract with a third party to assert, any subrogation rights of Client in regard to payments for workers’ compensation benefits. Client will receive any subrogation recoveries obtained by Servicing Company. Services of independent contractors may be incurred by Servicing Company as an allocated loss adjustment expense. d. Set financial reserves to expected or probable outcomes based on industry best practices, and facts and opinions of experts retained during the claim investigation. e. Report claims to excess or aggregate reinsurer pursuant to the terms of the Client’s policy. f. Calculate average weekly wage and wage loss benefits using wage information provided by the Client. g. Engage nurse case managers, vocational rehabilitation consultants and return to work coordinators as an allocated loss adjustment expense. h. Perform annual claim reviews.
Sample 1
Claims Administration Services 
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Related to Claims Administration Services

  • 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.

  • Administration Services When a medical prescription drug is administered by infusion, the administration of the prescription drug may be covered separately from the prescription drug. See Infusion Therapy - Administration Services in the Summary of Medical Benefits for benefit limits and the amount you pay. Prescription drugs that are self-administered are not covered as a medical benefit but may be covered as a pharmacy benefit. Please see Pharmacy Prescription Drugs and Diabetic Equipment or Supplies – Pharmacy Benefits section above for additional information. For some medical prescription drugs, after the first administration, coverage may be limited to certain locations (for example, a designated outpatient or ambulatory service facility, physician’s office, or your home), provided the location is appropriate based on your medical status. For a list of medical prescription drugs that are subject to this Site of Care Program, visit our website. Preauthorization may be required to determine medical necessity as well as appropriate site of care. If we deny your request for preauthorization, or you disagree with our determination for the appropriate site of care, you can submit a medical appeal. See Appeals in Section 5 for information on how to file a medical appeal.

  • REGULATORY ADMINISTRATION SERVICES BNY Mellon shall provide the following regulatory administration services for each Fund and Series:  Assist the Fund in responding to SEC examination requests by providing requested documents in the possession of BNY Mellon that are on the SEC examination request list and by making employees responsible for providing services available to regulatory authorities having jurisdiction over the performance of such services as may be required or reasonably requested by such regulatory authorities;  Assist with and/or coordinate such other filings, notices and regulatory matters and other due diligence requests or requests for proposal on such terms and conditions as BNY Mellon and the applicable Fund on behalf of itself and its Series may mutually agree upon in writing from time to time; and

  • Claims Administrator Pursuant to the Preliminary Approval Order, and subject to Court approval, Interim Co- Lead Counsel shall engage a qualified Claims Administrator. The Claims Administrator will assist with the settlement claims process as set forth herein. 1. The Claims Administrator shall effectuate the notice plan approved by the Court in the Preliminary Approval Order, shall administer and calculate the claims, and shall oversee distribution of the Net Settlement Fund in accordance with the Plan of Distribution. 2. The Claims Administrator also shall assist in the development of the Plan of Distribution and the resolution of any disputes regarding the Plan of Distribution.

  • FUND ADMINISTRATION SERVICES BNY Mellon shall provide the following fund administration services for each Fund, Series and class:  Calculate Fund approved income and per share amounts required for periodic distributions to be made by the applicable Fund, Series or class;  Coordinate a Fund’s annual audit and respond timely and completely to related requests;  Cooperate with each Fund’s independent auditors;  Supply various normal and customary portfolio and Fund statistical data as requested on an ongoing basis; and  If the chief executive officer or chief financial officer of a Fund is required to provide a certification as part of the Fund’s Form N-Q or Form N-CSR filing pursuant to regulations promulgated by the SEC under Section 302 of the Xxxxxxxx-Xxxxx Act of 2002, provide a sub-certification in support of certain matters set forth in the aforementioned certification. Such sub-certification is to be in such form and relating to such matters as reasonably agreed to by BNY Mellon in advance. BNY Mellon shall be required to provide the sub-certification only during the term of this Agreement with respect to the applicable Fund or Series and only if it receives such cooperation as it may request to perform its investigations with respect to the sub-certification. For clarity, the sub-certification is not itself a certification under the Xxxxxxxx-Xxxxx Act of 2002 or under any other law, rule or regulation. BNY Mellon shall provide the following regulatory administration services for each Fund and Series:  Assist the Fund in responding to SEC examination requests by providing requested documents in the possession of BNY Mellon that are on the SEC examination request list and by making employees responsible for providing services available to regulatory authorities having jurisdiction over the performance of such services as may be required or reasonably requested by such regulatory authorities;  Assist with and/or coordinate such other filings, notices and regulatory matters and other due diligence requests or requests for proposal on such terms and conditions as BNY Mellon and the applicable Fund on behalf of itself and its Series may mutually agree upon in writing from time to time; and

  • OUR SERVICES As insurance intermediaries we generally act as the agent of our client. We are subject to the law of agency, which imposes various duties on us. However, in certain circumstances we may act for and owe duties of care to other parties, including the insurer. We will advise you when these circumstances occur, so you will be aware of any possible conflict of interest. We offer a wide range of products and services which may include: • Offering you a single or range of products from which to choose a product that suits your insurance needs; • Advising you on your insurance needs; • Arranging suitable insurance cover with insurers to meet your requirements; • Helping you with any subsequent changes to your insurance you have to make; • Providing all reasonable assistance with any claim you make. In some cases, we act for insurers under a delegated authority agreement and can enter into insurance policies, issue policy documentation and/or handle or settle claims on their behalf. Where we act on behalf of the insurer and not you, we will notify you accordingly and in relation to claims we will advise you of this fact when you notify us of a claim. Notwithstanding this, we endeavour to always act in your best interest. As intermediaries, we offer a wide range of insurance products and have access to many leading insurance companies and the Lloyd’s market. Depending on the type of cover you require and where we have provided advice based on a personal recommendation, we will offer you a policy from either: • a single insurer; • a limited range of insurers; or • a fair analysis that is representative of the insurance market. We will advise you separately as to which of these apply before we arrange your policy and where we have not undertaken a fair analysis of the market, we will provide you with a list of insurers considered. Jensten Retail Consumer Client TOBA Version 1.0 Nov 2021 Policies taken out, amended, or renewed through our online service will be on a non-advised basis. This means sufficient information will be provided for you to make an informed decision about any product purchased online and you should therefore ensure that any policy provides the cover you require and is suitable for your needs. For Motor Vehicle insurance we require customers to pay an additional charge for our claims service – Coversure Claimsline (details are provided in a separate document). This is a “one-stop” service that enables us to assist you with any claim you may incur. The cost of the Coversure Claimsline services will be included in the price quoted to you for the Motor Vehicle insurance and shown separately in your documentation. By purchasing motor insurance from us, you authorise Coversure and its agents to take all necessary actions to handle your claim including dealing with your insurers, third parties and their insurers and other service suppliers on your behalf. For all other policies, including optional additional products and premium finance (if relevant), before the insurance contract is concluded and after we have assessed your demands & needs, we will provide you with advice and make a personal recommendation. This will include sufficient information to enable you to make an informed decision about the policy that we have recommended, together with a quotation which will itemise any fees that are payable in addition to the premium. This documentation will also include a statement of your demands and needs. You should read this carefully as it will explain reasons for making the recommendation we have made.

  • Surgery Services This plan covers surgery services to treat a disease or injury when: • the operation is not experimental or investigational, or cosmetic in nature; • the operation is being performed at the appropriate place of service; and • the physician is licensed to perform the surgery. This plan covers reconstructive surgery and procedures when the services are performed to relieve pain, or to correct or improve bodily function that is impaired as a result of: • a birth defect; • an accidental injury; • a disease; or • a previous covered surgical procedure. Functional indications for surgical correction do not include psychological, psychiatric or emotional reasons. This plan covers the procedures listed below to treat functional impairments. • abdominal wall surgery including panniculectomy (other than an abdominoplasty); • blepharoplasty and ptosis repair; • gastric bypass or gastric banding; • nasal reconstruction and septorhinoplasty; • orthognathic surgery including mandibular and maxillary osteotomy; • reduction mammoplasty; • removal of breast implants; • removal or treatment of proliferative vascular lesions and hemangiomas; • treatment of varicose veins; or • gynecomastia.

  • Provider Services Charges for the following Services when ordered by a Physician for the treatment of an Injury or Illness.

  • Program Administration An activity relating to the general management, oversight and coordination of community development programs. Costs directly related to carrying out eligible activities are not included.

  • Administrative Services In addition to the portfolio management services specified above in section 2, you shall furnish at your expense for the use of the Fund such office space and facilities in the United States as the Fund may require for its reasonable needs, and you (or one or more of your affiliates designated by you) shall render to the Trust administrative services on behalf of the Fund necessary for operating as an open end investment company and not provided by persons not parties to this Agreement including, but not limited to, preparing reports to and meeting materials for the Trust's Board of Trustees and reports and notices to Fund shareholders; supervising, negotiating contractual arrangements with, to the extent appropriate, and monitoring the performance of, accounting agents, custodians, depositories, transfer agents and pricing agents, accountants, attorneys, printers, underwriters, brokers and dealers, insurers and other persons in any capacity deemed to be necessary or desirable to Fund operations; preparing and making filings with the Securities and Exchange Commission (the "SEC") and other regulatory and self-regulatory organizations, including, but not limited to, preliminary and definitive proxy materials, post-effective amendments to the Registration Statement, semi-annual reports on Form N-SAR and notices pursuant to Rule 24f-2 under the 1940 Act; overseeing the tabulation of proxies by the Fund's transfer agent; assisting in the preparation and filing of the Fund's federal, state and local tax returns; preparing and filing the Fund's federal excise tax return pursuant to Section 4982 of the Code; providing assistance with investor and public relations matters; monitoring the valuation of portfolio securities and the calculation of net asset value; monitoring the registration of Shares of the Fund under applicable federal and state securities laws; maintaining or causing to be maintained for the Fund all books, records and reports and any other information required under the 1940 Act, to the extent that such books, records and reports and other information are not maintained by the Fund's custodian or other agents of the Fund; assisting in establishing the accounting policies of the Fund; assisting in the resolution of accounting issues that may arise with respect to the Fund's operations and consulting with the Fund's independent accountants, legal counsel and the Fund's other agents as necessary in connection therewith; establishing and monitoring the Fund's operating expense budgets; reviewing the Fund's bills; processing the payment of bills that have been approved by an authorized person; assisting the Fund in determining the amount of dividends and distributions available to be paid by the Fund to its shareholders, preparing and arranging for the printing of dividend notices to shareholders, and providing the transfer and dividend paying agent, the custodian, and the accounting agent with such information as is required for such parties to effect the payment of dividends and distributions; and otherwise assisting the Trust as it may reasonably request in the conduct of the Fund's business, subject to the direction and control of the Trust's Board of Trustees. Nothing in this Agreement shall be deemed to shift to you or to diminish the obligations of any agent of the Fund or any other person not a party to this Agreement which is obligated to provide services to the Fund.