Claims Notification. You must contact Us with full details as soon as possible of any Disability, incident or on the discovery of any loss or damage which may result in a claim under this Policy. You must also tell Us if You know of any writ, summons, or prosecution against You and immediately send Us every letter or document which relates to a claim.
Claims Notification. HEBP will prepare and mail explanation of benefit forms for medical and dental claims.
Claims Notification. If any claim, or other action, including proceedings before an administrative agency, is made or brought by any person, firm, corporation, or other entity against Contractor or County in relation to the performance of this Contract, Contractor shall give written notice to County of the claim or other action within three (3) working days after being notified of it or the threat of it; the name and address of the person, firm, corporation or other entity that made or threatened to make a claim, or that instituted or threatened to institute any type of action or proceeding; the basis of the claim, action or proceeding; the court or administrative tribunal, if any, where the claim, action or proceeding was instituted; and the name or names of any person against whom this claim is being made or threatened. This written notice shall be given in the manner provided herein. Except as otherwise directed, Contractor shall furnish to County copies of all pertinent papers received by Contractor with respect to these claims or actions.
Claims Notification. (a) As soon as a Party becomes aware of the possibility of a claim involving indemnification under this Article V, the indemnified Party shall give the indemnifying Party prompt written notice in writing and shall permit the indemnifying Party to have control over the defense of such claim or suit. The indemnified Party agrees to provide all reasonable information and assistance to the indemnifying Party in such defense. No such claims shall be settled other than by the Party defending the same, and then only with the consent of the other Party, which shall not be unreasonably withheld or delayed; provided, however, that the indemnified Party shall have no obligation to consent to any settlement of any such claim which imposes on the indemnified Party any liability or obligation which cannot be assumed and performed in full by the indemnifying Party.
(b) As soon as any Party becomes aware of the possibility of a claim involving contribution under Section 5.4, such Party shall notify the other Parties and the Parties shall cooperate in the defense of such claim. Each of the Parties shall provide all reasonable information and assistance to such defense.
Claims Notification. A. The PH-MCO will provide the Department with semi-annual files as defined by the Department that include information on applicable services.
B. Each file must include all eligible procedures, including services provided by capitated providers, and must have dates of service within the applicable six month period. This file must contain all data elements as specified by the Department.
C. The PH-MCO may not include an allowance for claims that have not been paid.
D. Each file is due on or before a date specified by the Department, which will be at least six months following the end of the applicable six month period.
E. The Department will include in its calculation only services rendered by a physician who is eligible on the date of service per the Department’s current file.
Claims Notification. In the event of any occurrence which may give rise to a claim under this Policy the Insured shall as soon as possible give notice thereof to the Company with full particulars. Every letter claim writ of summons and process shall be notified or forwarded to the Company immediately on receipt.
Claims Notification. The Insured must provide written notification to the Insurer no later than 35 days of the occurring of any Accident Incident event or circumstance which may give rise which is covered under this Extension. The following special extensions shall be payable in addition to any benefit paid under the Personal Accident Section – Nuclear Chemical or Biological Cause Extension Benefits 1 – 4 of the Policy subject to the Maximum Incident Limit (and inner limits where applicable) as detailed in the Schedule If during the Operative Time the Insured Person sustains an Accident resulting in Bodily Injury or contracts illness which within 26 weeks is the sole and independent cause of Death for which Benefit 1 is paid the Insurer will pay necessary expenses with the Insurer’s prior written consent for either • telephone counselling or • face to face counselling or • cognitive behavioural therapy as deemed appropriate by the Insurer to the Insured Person’s Spouse or Child up to £250 per week up to a maximum £5,000 any one Insured Person If during the Period of Insurance any single Incident results in payment of the Death benefit for five or more Directors or Employees of the Insured who are covered under the Personal Accident Insurance – Nuclear Chemical or Biological Cause Extension the Insurer will pay necessary expenses with the Insurer’s prior written consent for specialist counselling support services for any Director or Employee of the Insured up to a maximum £5,000 If during the Operative Time the Insured Person sustains an Accident resulting in Bodily Injury or contracts illness which within 26 weeks is the sole and independent cause of Disablement for which Benefit 2, 3, or 4 is paid the Insurer will pay necessary expenses with the Insurer’s prior written consent for either • telephone counselling or • face to face counselling or • cognitive behavioural therapy as deemed appropriate by the Insurer to the Insured Person up to £250 per week up to a maximum £5,000 any one Insured Person If during the Operative Time the Insured Person sustains an Accident resulting in Bodily Injury or contracts illness which within 26 weeks is the sole and independent cause of Disablement for which Benefit 2 3 or 4 is claimed the Insurer will pay necessary expenses incurred with the Insurer’s prior written consent to make alterations to the Insured Person’s home car or usual place of work as a direct and necessary result of the Disablement suffered up to a maximum of £25,000 If duri...
Claims Notification. On the happening of an occurrence likely to give rise to a claim contact: The Intermediary who arranged the insurance, details as noted on the schedule or The Chubb Claims Service Team.
Claims Notification. 4.1.1 The insured will give notice in writing to the insurer as soon as reasonably practicable and at least within: a) ninety (90) days from the date of accident of the insured person that causes or may cause temporary total disablement or temporary partial disablement insured by this policy; b) ninety (90) days from the date of accident of the insured person that causes or may cause death or permanent disablement insured by this policy; or
Claims Notification. A. The PH-MCO will provide the Department with a quarterly file that includes information on each Covered Member for whom a payment for a Covered Service has been made. Each quarterly file will provide cumulative information on payments made for dates of service within one Arrangement Year. The file will include data elements specified by the Department.
B. The PH-MCO will not include an allowance for claims that have not been paid.
C. If a provider payment is subsequently reduced or taken back by the PH- MCO, the PH-MCO will report this information on the quarterly file.
D. Each quarterly file is due on or before the date indicated in a submission schedule issued by the Department. The PH-MCO will submit a quarterly file for the current Arrangement Year, plus any file that is due for a previous Arrangement Year.
E. The submission schedule includes quarterly submissions which are optional, those which are required, and instances where there should be no submission. For an optional submission, if the PH-MCO elects not to submit a file, it will notify the Department by the due date of the submission.
F. The Department may elect to use encounter data in lieu of PH-MCO file submissions.
