Common use of Claims Administration Clause in Contracts

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 fulfillment of the terms and conditions of this Policy (including payment of premium by the due dates mentioned in the Policy Schedule / Certificate of InsuranceSchedule) 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. (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. (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 or failure to follow such directions, advice or guidance; c. (c) If requested by Us and at Our cost, We may conduct Medical the Insured Person must submit to medical examination by any Our nominated Medical Practitioner for this purpose when and so as often as We may reasonably require. Such consider reasonable and necessary and We/Our representatives must be permitted to inspect the medical examination will be carried out only in case of reimbursement claims with prior consent of and Hospitalization records pertaining to the Insured Person’s treatment and to investigate the facts surrounding the Claim; d. (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 fulfillment of the terms and conditions of this Policy (including payment of premium by the due dates mentioned in the Policy Schedule / Certificate of InsuranceSchedule) 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. (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. (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 or failure to follow such directions, advice or guidance; c. (c) If requested by Us and at Our cost, We may conduct Medical the Insured Person must submit to medical examination by any Our nominated Medical Practitioner for this purpose when and so as often as We may reasonably require. Such consider reasonable and necessary and We/Our representatives must be permitted to inspect the medical examination will be carried out only in case of reimbursement claims with prior consent of and Hospitalization records pertaining to the Insured Person’s treatment and to investigate the facts surrounding the Claim; d. (d) We/Our representatives must be given all reasonable co-co- operation in investigating the claim in order to assess Our liability and quantum in respect of such Claim;

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 InsuranceSchedule) 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 conditions precedent to admission of Our liability under this Policy: a. Claims shall be settled by Us, (i) On the occurrence or discovery of any event Injury that may give rise to a Claim under this Policy, the Claims Procedure set out below shall be followed; b. (ii) 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 or failure to follow such directions, advice or guidance; c. (iii) If requested by Us and at Our cost, We may conduct Medical the Insured Person must submit to medical examination by any Our nominated Medical Practitioner for this purpose when and so as often as We may reasonably require. Such consider reasonable and necessary and We/Our representatives must be permitted to inspect the medical examination will be carried out only in case of reimbursement claims with prior consent of and Hospitalization records pertaining to the Insured Person’s treatment and to investigate the facts surrounding the Claim; d. (iv) 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 fulfillment fulfilment of the terms and conditions of this Policy (including payment of premium by the due dates mentioned in the Policy Schedule / Schedule/ Certificate of Insurance) insofar as they relate to anything to be done or complied with by You or any the Insured Person, including complying with the following in relation to claims, Person shall be Conditions Precedent conditions precedent to admission of Our liability under this Policy: a. Claims shall be settled by Us, a) On the occurrence or discovery of any event Injury that may give rise to a Claim under this Policy, the Claims Procedure set out below shall be followed; b. 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. 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 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 facts surrounding the Claim; d. d) We/Our representatives must be given all reasonable co-operation in investigating the claim Claim in order to assess Our liability and quantum in respect of such Claim;

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 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-co- operation in investigating the claim in order to assess Our liability and quantum in respect of such Claim;

Claims Administration. The fulfillment fulfilment of the terms and conditions of this Policy (including payment of premium by the due dates mentioned in the Policy Schedule / Schedule/ Certificate of Insurance) insofar as they relate to anything to be done or complied with by You or any the Insured Person, including complying with the following in relation to claims, Person shall be Conditions Precedent conditions precedent to admission of Our liability under this Policy: a. Claims shall be settled by Us, a) On the occurrence or discovery of any event Injury that may give rise to a Claim under this Policy, the Claims Procedure set out below shall be followed; b. 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. 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 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 facts surrounding the Claim; d. d) We/Our representatives must be given all reasonable co-co- operation in investigating the claim Claim in order to assess Our liability and quantum in respect of such Claim;

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. (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. (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. (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. (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 fulfillment of the terms and conditions of this Policy (including payment of premium by the due dates mentioned in the Policy Schedule / Certificate of InsuranceSchedule) 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 conditions precedent to admission of Our liability under this Policy:: Page11 a. Claims shall be settled by Us, (i) On the occurrence or discovery of any event Injury that may give rise to a Claim under this Policy, the Claims Procedure set out below shall be followed; b. (ii) 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 or failure to follow such directions, advice or guidance; c. (iii) If requested by Us and at Our cost, We may conduct Medical the Insured Person must submit to medical examination by any Our nominated Medical Practitioner for this purpose when and so as often as We may reasonably require. Such consider reasonable and necessary and We/Our representatives must be permitted to inspect the medical examination will be carried out only in case of reimbursement claims with prior consent of and Hospitalization records pertaining to the Insured Person’s treatment and to investigate the facts surrounding the Claim; d. (iv) 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 fulfillment fulfillment of the terms and conditions of this Policy (including payment of premium by the due dates mentioned in the Policy Schedule / Certificate of InsuranceSchedule) 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. (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. (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 or failure to follow such directions, advice or guidance; c. (c) If requested by Us and at Our cost, We may conduct Medical the Insured Person must submit to medical examination by any Our nominated Medical Practitioner for this purpose when and so as often as We may reasonably require. Such consider reasonable and necessary and We/Our representatives must be permitted to inspect the medical examination will be carried out only in case of reimbursement claims with prior consent of and Hospitalization records pertaining to the Insured Person;’s treatment and to investigate the facts surrounding the Claim; Page 6; Kotak Mahindra General Insurance Company Ltd.; Kotak Secure Shield UIN; IRDAI/HLT/KMGI/P-H/V.I/06/2016-17; Policy Wording d. (d) We/Our representatives must be given all reasonable co-co- operation in investigating the claim in order to assess Our liability and quantum in respect of such Claim;

Claims Administration. The fulfillment fulfilment of the terms and conditions of this Policy (including payment of premium by the due dates mentioned in the Policy Schedule / Schedule/ Certificate of Insurance) insofar as they relate to anything to be done or complied with by You or any the Insured Person, including complying with the following in relation to claims, Person shall be Conditions Precedent conditions precedent to admission of Our liability under this Policy: a. Claims shall be settled by Us, a) On the occurrence or discovery of any event Injury that may give rise to a Claim under this Policy, the Claims Procedure set out below shall be followedfollow ed; b. 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. 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 w ill be carried out only in case of reimbursement claims with w ith prior consent c onsent of the Insured Person 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 facts surrounding the Claim; d. d) We/Our representatives must be given all reasonable co-operation in investigating the claim Claim in order to assess Our liability and quantum in respect of such Claim;

Claims Administration. Page10 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 InsuranceSchedule) 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. (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. (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 or failure to follow such directions, advice or guidance; c. (c) If requested by Us and at Our cost, We may conduct Medical the Insured Person must submit to medical examination by any Our nominated Medical Practitioner for this purpose when and so as often as We may reasonably require. Such consider reasonable and necessary and We/Our representatives must be permitted to inspect the medical examination will be carried out only in case of reimbursement claims with prior consent of and Hospitalization records pertaining to the Insured Person’s treatment and to investigate the facts surrounding the Claim; d. (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 fulfillment fulfilment of the terms and conditions of this Policy (including payment of premium by the due dates mentioned in the Policy Schedule / Schedule/ Certificate of Insurance) insofar as they relate to anything to be done or complied with by You or any the Insured Person, including complying with the following in relation to claims, Person shall be Conditions Precedent conditions precedent to admission of Our liability under this Policy: a. Claims shall be settled by Us, a) On the occurrence or discovery of any event Injury that may give rise to a Claim under this Policy, the Claims Procedure set out below shall be followedfollow ed; b. 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. 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 w ill be carried out only in case of reimbursement claims with c laims w ith prior consent of the Insured Person 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 facts surrounding the Claim; d. d) We/Our representatives must be given all reasonable co-operation in investigating the claim Claim in order to assess Our liability and quantum in respect of such Claim;