Claims Payments Clause Samples

Claims Payments. For Included Services, The Plan will send an initial payment or notice of denial of payment directly to the provider.

Claims Payments. The Contractor shall only accept from providers the uniform claim forms approved by the Department and completed according to Department guidelines.

Claims Payments. Subject to the provisions of this Agreement, in exchange for its interest in Proceeds resulting from the Subject Claim pursuant to Section 7 of this Agreement, the Funder agrees to pay for the purpose of funding Fees and Expenses (defined below) regarding the Subject Claim (the “Claims Payments”) incrementally and at the Funder’s sole discretion in accordance with the Costs Plan as may be approved by the Funder from time to time.

Claims Payments. 30. This settlement shall be a claims-made settlement. To be eligible for a Claim Payment under this settlement, a Settlement Class Member or his or her Legally Authorized Representative must timely submit a Claim Form or Electronic Claim Form and must not have submitted a request for exclusion. Allstate shall not be obligated to make any Claim Payments until after the Effective Date. 31. The Claim Payment paid to eligible class members who submit timely and valid claims will be the amount of unpaid Sales Tax, Title and Tag Fees, plus prejudgment interest calculated as follows:

Claims Payments. The review, payment, settlement or compromise of all claims and losses relating to the Coinsured Policies shall be handled by the Reinsurer, in its capacity as service provider, in accordance with the terms and conditions of the Administration Agreement. The Company shall have the right to make ultimate decisions regarding the contesting, compromise, or settlement of a claim with respect to a Coinsured Policy. The Reinsurer shall be bound by all such ultimate decisions of the Company, provided that: (i) the Company shall consult with the Reinsurer prior to the Company's exercise of its decision-making authority pursuant to this Section 9.3, (ii) all decisions of the Company made hereunder shall (w) comply with the terms of the Coinsured Policies, (x) comply with all material laws, regulations and orders applicable to the Company with respect to the Coinsured Policies and to the conduct of the activities contemplated hereby, (y) be consistent with prudent management practices in the life and health insurance industry generally, and (z) comply with the Standards of Performance as referenced and described in the Administration Agreement, and (iii) the Reinsurer shall have no liability for costs and expenses incurred hereunder that arise out of, are based on or related to any bad faith claims practices, willful misconduct, fraud or gross negligence of the Company or its Affiliates (without attributing to the Company or its Affiliates the actions of the Reinsurer or its Affiliates). In the event the Company intends to exercise its decision-making authority hereunder, it shall give prompt notice to the Reinsurer of such action, but in no event later than ten (10) Business Days prior to the date of such exercise of authority, or such lesser period as is commerically reasonable for the Company and the Reinsurer under the circumstances.

Claims Payments. NYLCare Mid-Atlantic is solely responsible for making payments for any and all claims for non-capitated Covered Services in cooperation with Doctors Health and otherwise in accordance with the procedures in this Section 2.16. Claims payments to Participating Providers for non-capitated Covered Services, processed and approved strictly in accordance with this Section 2.16, shall be made by NYLCare Mid-Atlantic and then deducted from the compensation due Doctors Health under Section 2.5 of this Agreement subject to all of the conditions set forth in subparagraph 2.16.3 below.

Claims Payments. In accordance with the Balanced Budget Act (BBA) Section 4708, the Contractor shall implement Claims payment procedures that ensure 90% of all Provider Claims for which no further written information or substantiation is required in order to make payment are paid or denied within thirty (30) days of the date of receipt of such Claims and that 99% of all Claims are processed within ninety (90) days of the date of receipt of such Claims. In addition, the Contractor shall comply with the Prompt-Pay statute, codified within KRS 304.17A-700-730, as may be amended, and KRS 205.593, and KRS 304.14-135 and KRS 304.99-123, as may be amended. The Contractor shall, notify the requesting provider of any decision to deny a Claim, or to authorize a service in an amount, duration, or scope that is less than requested. Any conflict between the BBA and Commonwealth law will default to the BBA unless the Commonwealth requirements are stricter.

Claims Payments. 1. To be eligible for a Claim Payment under this Settlement, a Settlement Class Member or his or her Legally Authorized Representative must timely submit a complete Claim Form and must not have submitted a request for exclusion. 2. The Maximum Claim Payment paid to each individual Eligible Class Member who submits a timely, complete, and valid claim will be calculated as follows: PGAC will pay the difference between (a) the full unearned premium and (b) the 90% unearned pro rata premium that was previously credited to the policy at the time of cancellation, plus 5% of the unreimbursed difference as agreed-to interest. For ease of administration and to assist in the calculations on individual claims, the Parties agree that they will use a spreadsheet (copies of which have been exchanged and which shall be maintained confidentially by Defendant’s counsel and Class Counsel) which includes the calculated difference between the full unearned premium and the 90% unearned pro rata premium that was previously credited to the policy at the time of cancellation for each Settlement Class Member, adding 5% of the unreimbursed difference. The calculations in this spreadsheet shall govern the amounts to be paid to Settlement Class Members who timely submit a complete and valid Claim Form; however, in the cases in which a balance is still owed by a Settlement Class Member to PGAC (even after the refund is applied) or the amount of the refund equals the balance still owed to PGAC, there will be no payment on the claim. 3. If premium refunds were previously paid to a Settlement Class Member in an amount less than the Maximum Claim Payment, PGAC will pay the difference between what was already paid and the amounts set forth above. To the extent PGAC already paid an amount equaling or exceeding the Maximum Claim Payment, the payment or overpayment shall be offset against the Maximum Claim Payment amount. In no event shall a Settlement Class Member be required to refund any money to PGAC. 4. The payment described herein in this Section V is the only payment to which Settlement Class Members are entitled under this Agreement. No additional amounts shall be paid. The payments shall be in full and final disposition of the Action, and in consideration for the release of any and all Released Claims as against any and all Released Persons. Any rights to settlement Claim Payments under this Agreement shall inure solely to the benefit of Settlement Class Members and are not transfera...

Claims Payments. ‌ 29. To be eligible for a Claim Payment under this settlement, a Settlement Class Member or his or her Legally Authorized Representative must timely submit a valid Claim Form or Electronic Claim Form and must not have submitted a request for exclusion. GEICO shall not be obligated to make any Claim Payments until after the Effective Date. 30. Eligible Class Members are Settlement Class Members that submit timely and valid claims relating to a Covered Total Loss Claim that are not excluded from the Settlement Class and that were not paid the full amount of Sales Tax and/or Title and Tag Transfer Fees. Each Eligible Class Member will receive a payment from GEICO calculated by: (1) determining the Sales Tax for the vehicle that was the subject of the Covered Total Loss Claim; subtracting (2) any Prior Sales Tax Payment made by GEICO on the claim; and (3) adding an additional $79.85 (minus any Title and Tag Transfer Fees paid relating to the Covered Total Loss Claim), plus prejudgment interest. For example, if the Sales Tax was $ 1400.00 and a prior payment included $ 100.00 for sales tax, the Eligible Class Member will receive a payment of $ 1379.85, calculated as follows: Sales Tax = $ 1,400.00 Amount of Prior Sales Tax Payment = $ 100.00 $ 1400.00 - $ 100.00 = $ 1,300.00 $ 1,300.00 + 79.85 = $ 1,379.85 In addition, the eligible class member will receive prejudgment interest on that amount. 31. Prejudgment interest will be calculated by the applicable rate set by the State of Florida from the salvage close date or, if there is no salvage close date, 30 days after the date of loss associated with the claim, including any changes in the rate during the time period since that date until 60 days after the date the Order of Preliminary Approval is entered. 32. The Settlement Administrator shall establish procedures for receiving and processing Claim Forms and Electronic Claim Forms. 33. The Claim Payment described herein is the only payment to which Settlement Class Members, other than Plaintiffs, are entitled under this Agreement. The payments are deemed to be inclusive of any claims for any potentially applicable penalties and/or interest and/or fees. The payments shall be in full and final disposition of the Action, and in consideration for the release of any and all Released Claims as against any and all Released Persons.