Claims Guidelines, Standards and Procedures Sample Clauses

Claims Guidelines, Standards and Procedures. The Ceding Company’s adherence to its claim guidelines, standards and procedures (“Claims Procedures”), is a condition precedent to the payment of any reinsurance benefits under this Agreement. The Ceding Company has provided a copy of the Claims Procedures to Munich Re, U.S. (Life), and the Ceding Company shall notify Munich Re, U.S. (Life) within ninety (90) days of the effective date of any proposed material change to the Claims Procedures. If Munich Re, U.S. (Life) agrees to the proposed change in writing, such change shall become part of the Claims Procedures. In the event that Munich Re, U.S. (Life) does not respond within thirty (30) days, Munich Re, U.S. (Life) shall be deemed to have accepted such proposed change. If Munich Re, U.S. (Life) rejects such proposed change in writing, such proposed change shall not be applied to claims processed for Policies reinsured under this Agreement. It is the Ceding Company’s sole decision to determine whether to investigate, contest, compromise or litigate a claim; however, the Ceding Company is responsible for investigating, contesting, compromising or litigating Policy claims in accordance with applicable law and Policy terms. The Ceding Company acknowledges that it follows industry standards and investigates claims with any of the following criteria: a. If the claim occurs within the contestable period as defined by the Policy; or b. If there is a reasonable question regarding the validity of the insured’s death or the authenticity of the proof of death; or c. If the death occurs outside the United States or Canada; or d. If the insured is missing or presumed dead; or e. If there is a reasonable suspicion of fraud. A claim investigation generally includes confirming proof of death, and, if material, medical records to validate the insured’s medical disclosures and financial condition at the time of Policy application. Investigations may also include obtaining police reports, coroner’s reports, financial records, or other information that would be appropriate under the circumstances. The Ceding Company acknowledges that it does defend against claims meeting the following criteria: a. If a material misrepresentation is found in the application and the policy is within the contestable period; or b. If fraud is found and there is a legal remedy available; or c. If there is insufficient proof of death. Munich Re, U.S. (Life) shall not be liable for any Claim Exception made by the Ceding Company related to any Pol...
Sample 1
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Claims Guidelines, Standards and Procedures. (a) The Company’s material compliance with its then applicable claim guidelines, standards and procedures (collectively, “Claims Procedures”), is a condition precedent to the payment of any reinsurance benefits under this Agreement. The Company will provide a copy of the Claims Procedures to the Reinsurer upon request. The Company shall notify the Reinsurer within at least thirty (30) days prior to the effective date of any proposed material change (as determined by the Company, in its sole discretion) to the Claims. If the Reinsurer agrees to the proposed change in writing within thirty (30) days from the date of notice, such change shall become part of the Claims Procedures. If the Reinsurer does not respond within thirty (30) days from the date of notice, the Reinsurer shall be deemed to have accepted such proposed change and such change shall become part of the Claims Procedures. If the Reinsurer objects to such proposed change in writing within thirty (30) days from the date of notice, such objection shall be in writing and shall provide, in sufficient detail, the Reinsurer’s good faith objection to such proposed change based on the Reinsurer’s good faith belief that the proposed change, if implemented, will have a material effect on the Reinsurer’s risk assumed under the Agreement. At the Company’s request, the Reinsurer shall discuss its objection to such proposed change with the Company. The parties will act in good faith to come to a mutual agreement. (b) The Company shall provide the Reinsurer with notice of any Claim Exception made by the Company related to any policy reinsured under this Agreement. For purposes of the Agreement a “Claim Exception” is a decision made by the Company to deny or pay a claim that: (i) violates the express terms of the applicable policy; (ii) violates the express provisions of the Company’s Claims Procedures; or (iii) to the knowledge of the Company, violates applicable law.
Sample 1

Related to Claims Guidelines, Standards and Procedures

  • COMPLIANCE WITH POLICIES AND PROCEDURES During the period that Executive is employed with the Company hereunder, Executive shall adhere to the policies and standards of professionalism set forth in the policies and procedures of the Company and IAC as they may exist from time to time.

  • Policies and Procedures i) The policies and procedures of the designated employer apply to the employee while working at both sites. ii) Only the designated employer shall have exclusive authority over the employee in regard to discipline, reporting to the College of Nurses of Ontario and/or investigations of family/resident complaints. iii) The designated employer will ensure that the employee is covered by WSIB at all times, regardless of worksite, while in the employ of either home. iv) The designated employer will ensure that the employee is covered by liability insurance at all times, regardless of worksite, while in the employ of either home. v) The designated employer shall have exclusive authority over the employee’s personnel files and health records. These files will be maintained on the site of the designated employer.

  • Safeguarding requirements and procedures (1) The Contractor shall apply the following basic safeguarding requirements and procedures to protect covered contractor information systems. Requirements and procedures for basic safeguarding of covered contractor information systems shall include, at a minimum, the following security controls: (i) Limit information system access to authorized users, processes acting on behalf of authorized users, or devices (including other information systems). (ii) Limit information system access to the types of transactions and functions that authorized users are permitted to execute. (iii) Verify and control/limit connections to and use of external information systems. (iv) Control information posted or processed on publicly accessible information systems. (v) Identify information system users, processes acting on behalf of users, or devices. (vi) Authenticate (or verify) the identities of those users, processes, or devices, as a prerequisite to allowing access to organizational information systems. (vii) Sanitize or destroy information system media containing Federal Contract Information before disposal or release for reuse. (viii) Limit physical access to organizational information systems, equipment, and the respective operating environments to authorized individuals. (ix) Escort visitors and monitor visitor activity; maintain audit logs of physical access; and control and manage physical access devices. (x) Monitor, control, and protect organizational communications (i.e., information transmitted or received by organizational information systems) at the external boundaries and key internal boundaries of the information systems. (xi) Implement subnetworks for publicly accessible system components that are physically or logically separated from internal networks. (xii) Identify, report, and correct information and information system flaws in a timely manner. (xiii) Provide protection from malicious code at appropriate locations within organizational information systems. (xiv) Update malicious code protection mechanisms when new releases are available. (xv) Perform periodic scans of the information system and real-time scans of files from external sources as files are downloaded, opened, or executed.

  • Policies, Guidelines, Directives and Standards Either the Funder or the Ministry will give the HSP Notice of any amendments to the manuals, guidelines or policies identified in Schedule C. An amendment will be effective in accordance with the terms of the amendment. By signing a copy of this Agreement the HSP acknowledges that it has a copy of the documents identified in Schedule C.

  • Policy and Procedures If the resident leaves the facility due to hospitalization or a therapeutic leave, the facility shall not be obligated to hold the resident’s bed available until his or her return, unless prior arrangements have been made for a bed hold pursuant to the facility’s “Bed Reservation Policy and Procedure” and pursuant to applicable law. In the absence of a bed hold, the resident is not guaranteed readmission unless the resident is eligible for Medicaid and requires the services provided by the facility. However, the resident may be placed in any appropriate bed in a semi-private room in the facility at the time of his or her return from hospitalization or therapeutic leave provided a bed is available and the resident’s admission is appropriate and meets the readmission requirements of the facility.

  • Company Policies and Procedures 7.1.1 The Company will ensure that Employees are able to readily access Company policies and procedures that apply to the Employees. 7.1.2 The Employees will observe and act in accordance with Company policies and procedures that apply to the Employees, as implemented and amended from time to time.

  • Rules and Procedures The Benefit Society By-Laws will be amended to provide for a 6th Director with three Directors appointed by the Unions and three Directors appointed by the Corporation.

  • Compliance Policies and Procedures To assist the Fund in complying with Rule 38a-1 of the 1940 Act, BBH&Co. represents that it has adopted written policies and procedures reasonably designed to prevent violation of the federal securities laws in fulfilling its obligations under the Agreement and that it has in place a compliance program to monitor its compliance with those policies and procedures. BBH&Co will upon request provide the Fund with information about our compliance program as mutually agreed.

  • Ordering Guidelines and Processes 1.13.1 For information regarding Ordering Guidelines and Processes for various Network Elements, Combinations and Other Services, PLI should refer to the “Guides” section of the BellSouth Interconnection Web site, which is incorporated herein by reference, as amended from time to time. The Web site address is: http//xxx.xxxxxxxxxxxxxxx.xxxxxxxxx.xxx/. 1.13.2 Additional information may also be found in the individual CLEC Information Packages, which are incorporated herein by reference, as amended from time to time, located at the “CLEC UNE Products” Web site address: xxxx://xxx.xxxxxxxxxxxxxxx.xxxxxxxxx.xxx/guides/html/unes.html. 1.13.3 The provisioning of Network Elements, Combinations and Other Services to PLI’s Collocation Space will require cross-connections within the central office to connect the Network Element, Combinations or Other Services to the demarcation point associated with PLI’s Collocation Space. These cross-connects are separate components that are not considered a part of the Network Element, Combinations or Other Services and, thus, have a separate charge pursuant to this Agreement.

  • Violence Policies and Procedures The Employer agrees to have in place explicit policies and procedures to deal with violence. The policy will address the prevention of violence, the management of violent situations, provision of legal counsel and support to employees who have faced violence. The policies and procedures shall be part of the employee's health and safety policy and written copies shall be provided to each employee. Prior to implementing any changes to these policies, the employer agrees to consult with the Association.

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