Claims Forms. If General Liability, Pollution and/or Asbestos Pollution Liability and/or Errors & Omissions coverage are written on a claims-made form:
(a) Retro Date. The “Retro Date” must be shown, and must be before the date of the contract or the beginning of the contract work.
Claims Forms. The City and the LPOA will agree upon a claim form for use to replace or repair damaged or destroyed equipment/property. Any claim will be made to the employee’s supervisor, verified and approved for submittal to the Chief of Police through the normal chain of command. The Chief of Police or his/her representative will submit the claim to the City for replacement or repair.
Claims Forms. A claim form can be requested by calling the Member and Provider Service telephone number on the identification card during regular business hours. CareFirst BlueChoice shall provide claim forms for filing proof of loss to each claimant. If CareFirst BlueChoice does not provide the claim forms within fifteen (15) days after notice of claim is received, the claimant is deemed to have complied with the requirements of the policy as to proof of loss if the claimant submits, within the time fixed in the policy for filing proof of loss, written proof of the occurrence, character, and extent of the loss for which the claim is made. When a Member subject to a Medical Child Support Order or a Qualified Medical Support Order does not reside with the Subscriber, CareFirst will
1. Send the non-insuring, custodial parent identification cards, claims forms, the applicable certificate of coverage or member contract, and any information needed to obtain benefits;
2. Allow the non-insuring, custodial parent or a provider of a Covered Service to submit a claim without the approval of the Subscriber; and
3. Provide benefits directly to:
a) The non-insuring, custodial parent;
b) The provider of the Covered Services, Covered Dental Services or Covered Vision Services; or
c) The appropriate child support enforcement agency of any state or the District of Columbia.
Claims Forms. The insurer, upon receipt of a written notice of claim, will furnish to the claimant such forms as are usually furnished by it for filing proofs of loss. If such forms are not furnished within 15 days after the giving of such notice the claimant shall be deemed to have complied with the requirements of this policy as to proof of loss upon submitting, within the time fixed in the policy for filing proofs of loss, written proof covering the occurrence, the character and the extent of the loss for which claim is made. Written proof of loss must be furnished to the insurer, in the case of claim for loss for benefits, within 90 days after the termination of the period for which the insurer is liable, and in case of claim for any other loss, within 90 days after the date of such loss. Failure to furnish such proof within the time required shall not invalidate nor reduce any claim if it was not reasonably possible to give proof within such time, provided such proof is furnished as soon as reasonably possible and in no event, except in the absence of legal capacity of the employee, later than one year from the time proof is otherwise required. Indemnities payable under this policy for any loss other than benefits will be paid as they accrue immediately upon receipt of due written proof of such loss. Subject to due written proof of such loss, all accrued indemnity for benefits will be paid Weekly or Monthly to the insured employee and any balance remaining unpaid upon the termination of the period of liability will be paid immediately upon receipt of due written proof.
Claims Forms. A claim form can be requested by calling the Member and Provider Service telephone number on the identification card during regular business hours. CareFirst BlueChoice shall provide claim forms for filing proof of loss to each claimant. If CareFirst BlueChoice does not provide the claim forms within fifteen (15) days after notice of claim is received, the claimant is deemed to have complied with the requirements of the policy as to proof of loss if the claimant submits, within the time fixed in the policy for filing proof of loss, written proof of the occurrence, character, and extent of the loss for which the claim is made.
1. Send the non-insuring, custodial parent identification cards, claims forms, the applicable certificate of coverage or member contract, and any information needed to obtain benefits;
2. Allow the non-insuring, custodial parent or a provider of a Covered Service to submit a claim without the approval of the Subscriber; and
3. Provide benefits directly to:
a) The non-insuring, custodial parent;
b) The provider of the Covered Services, Covered Dental Services or Covered Vision Services; or
c) The appropriate child support enforcement agency of any state or the District of Columbia.
Claims Forms. The City and Union will agree on a claim form for use to reimburse the claimant for replacing or repairing damaged, destroyed, lost or stolen equipment/property as described in 14-2 and 14-3 above. Any claim for reimbursement will be made to the employee’s supervisor, verified and approved for submittal to the Fire Chief through the normal chain of command. The Fire Chief or his/her representative will submit the claim to the Human Resources Division for payment approval for the Finance Division to reimburse the amount approved for replacement or repair.
Claims Forms. CareFirst BlueChoice does not require a written notice of a claim. CareFirst BlueChoice, upon receipt of a notice of a claim, will send the Member claims forms. If claim forms are not sent within fifteen (15) days after CareFirst BlueChoice's receipt of the notice, the Member shall be deemed to have complied with the requirements of this Evidence of Coverage as to proof of loss upon submitting, within the time fixed in the Evidence of Coverage for filing proof of loss, written proof covering the occurrence, the character and the extent of the loss for which claim is made.
Claims Forms. If General Liability, Pollution and/or Asbestos Pollution Liability and/or Errors & Omissions coverage are written on a claims-made form:
Claims Forms. To be eligible to receive a Cash Benefit, a Settlement Class Member 5 must submit a Claim Form that is determined by the Settlement Administrator to be valid, pursuant 6 to the Claim Review Process set forth in Section 7.04, below. 7
8 a. A Claim Form must include the following information: (i) the full legal 9 name of the Settlement Class Member, (ii) the Settlement Class Member’s Claim Number, which 10 will be provided by the Settlement Administrator, (iii) a valid, current telephone number for the 11 Settlement Class Member, and (iv) a valid email address for the Settlement Class Member, if 12 available. 13
14 b. The Claim Form and Instructions for submission are attached to this 15 Agreement along with the Email Notice as Exhibit B. 16
17 c. Each Settlement Class Member shall affirm that their statements in the 18 Claim Form are true and correct to the best of their knowledge and belief. 19
Claims Forms. The Plan does not require a written notice of a claim. The Plan, upon receipt of a notice of a claim, will send the Member claims forms. If claim forms are not sent within fifteen (15) days after the Member gives the Plan notice of a claim, the Member shall be considered to have complied with the requirements of this Agreement as to proof of loss, if the Member submits, within the time stated in the Agreement for filing proof of loss, written proof of the occurrence, character, and the extent of the loss for which claim is made. Benefits under this Agreement will be paid within 30 days after receipt of a written proof of loss.
