Common use of Claims Processing Clause in Contracts

Claims Processing. 4.16 Within reasonable time of receiving a Claim Form and any accompanying documentation, the Settlement Administrator will review the documentation and/or AHM’s records and either confirm or deny the Settlement Class Member’s eligibility for the Benefit and/or out-of-pocket expense reimbursement (as applicable). 4.17 If the determination is to deny a Claim, the Settlement Administrator will send, within sixty (60) days after determination of denial, notice of the denial to the Settlement Class Member. Such notice will set forth the reason(s) for the denial and provide notice of the claimant’s right to contest the denial and request reconsideration and/or to attempt to cure any defect within thirty (30) days. On a quarterly basis after the Effective Date until all Claims have been processed, the Settlement Administrator will provide to Class Counsel a list of all Claims that have been denied, along with the Claim Forms and supporting documentation and other relevant information relating to the denial with appropriate PII redactions. 4.18 Claims that do not meet the requirements set forth in the Settlement Agreement shall be denied. Grounds for rejection include, but are not limited to, failure to provide Proof of Expenses or any other required information, untimely submission of the Claim Form, or submission of ineligible repair expenses. 4.19 A Settlement Class Member whose Claim has been denied may attempt to cure the deficiency or contest the decision denying the Claim by mailing to the Settlement Administrator at the mailing address for the administration of this Settlement, written notice containing information to attempt to cure any claim deficiencies or a statement of reasons the Settlement Class Member contests the denial, along with any additional supporting documentation (the “Contest Notice”). Any Contest Notice must be postmarked within thirty (30) days after the date of mailing by the Settlement Administrator of the notice of the denial of the Claim. The Contest Notice procedures shall be posted on the Settlement Website and shall also be provided in writing to any Settlement Class Member whose Claim is denied. 4.20 Within sixty (60) days after the Settlement Class Member mails the Contest Notice, the Settlement Administrator shall consider the claimant’s request for reconsideration and any materials submitted by the Settlement Class Member in support thereof, and mail to the Settlement Class Member a final determination of the Claim. The decision of the Settlement Administrator shall be final unless the Settlement Class Member submits the denied Claim to the National Center for Dispute Settlement for resolution as described in paragraph 4.21 below. 4.21 If the Settlement Administrator finally denies a Claim, the Settlement Class Member may appeal the denial to the National Center for Dispute Settlement for binding resolution in accordance with the terms and conditions of the NVLW that accompanied the Settlement Class Vehicle at the original point of sale or lease, except that any such appeal must be filed within ninety (90) days of final denial by the Settlement Administrator and any decision by the National Center for Dispute Settlement will be final and binding upon all parties. AHM will pay any cost charged by the National Center for Dispute Settlement for resolving the dispute. Each party shall be responsible for paying his, her, or its own attorneys’ fees and other expenses if he, she, or it decides to retain counsel. 4.22 By no later than one hundred and twenty (120) days after the Effective Date, AHM will provide to Settlement Class Members who timely filed valid Claims the Benefit and/or out- of-pocket expense reimbursement (as applicable). 4.23 If this settlement never becomes Final for any reason, no relief, Benefit, Extended Warranty or reimbursement of any kind shall be made to anyone pursuant to the Settlement Agreement.

Claims Processing. 4.16 Within reasonable time 1. Upon receipt of receiving a Claim Form and any accompanying documentation, the Settlement Administrator will review the documentation and/or AHM’s records and either confirm or deny the Settlement Class Member’s eligibility for the Benefit and/or out-of-pocket expense reimbursement (as applicable). 4.17 If the determination is to deny a Claim, the Settlement Administrator will sendshall review the Claim to determine whether the Claim meets all qualifications for payment set forth in this Settlement Agreement and shall notify Claimants who do not meet all qualifications. Within 60 days of receiving the Claim, within sixty (60) days after determination of denial, notice of the denial to the Settlement Class Member. Such notice will set forth administrator shall notify the reason(s) Claimant of: a. Any deficiency in required documentation and shall reasonably specify what documents and/or information, if any, are still needed for claims determination; b. The basis for the denial and provide notice of Settlement Administrator’s decision to deny a Claim, including the claimantspecific deficiencies in the Claim’s supporting documentation, if any; c. The Claimant’s right to contest the denial and request reconsideration and/or to attempt to cure any defect deficiency, including any deficiency that led to the Settlement Administrator’s denial of a Claim; and d. The initial determination of the amount owed for a Claim and/or notice that any determination as to Claims for payments from the Common Fund are going to be processed at the end of the claims period. 2. In response to receiving the written notice under section III.C.1, Claimants a. Attempt to cure the deficiency stated as justification for denying a Claim, by submitting the information and/or documentation identified by the Settlement Administrator as lacking in the Claim, within thirty (30) days45 days of receipt of the written notice. On a quarterly basis after The Settlement Administrators shall have 45 days from the Effective Date until all Claims have been processeddate of receiving the cure attempt to provide written notice to the Claimant stating its final determination as to the approval or denial of the Claim, and shall notify the Claimant that they are entitled to appeal the determination to the Settlement Administrator at no additional cost; or b. Accept the initial determination by the Settlement Administrator, which acceptance will be presumed if no cure attempt is received by the Settlement Administrators within 45 days of the date of the initial determination, at which point the Settlement Administrator will provide to Class Counsel a list of all Claims that have been denied, along Claimants with the Claim Forms and supporting documentation and other relevant information relating their final determination as to the denial with appropriate PII redactions. 4.18 Claims that do not meet the requirements set forth in the Settlement Agreement shall be denied. Grounds for rejection include, but are not limited to, failure to provide Proof of Expenses approval or any other required information, untimely submission of the Claim Form, or submission of ineligible repair expenses. 4.19 A Settlement Class Member whose Claim has been denied may attempt to cure the deficiency or contest the decision denying the Claim by mailing to the Settlement Administrator at the mailing address for the administration of this Settlement, written notice containing information to attempt to cure any claim deficiencies or a statement of reasons the Settlement Class Member contests the denial, along with any additional supporting documentation (the “Contest Notice”). Any Contest Notice must be postmarked within thirty (30) days after the date of mailing by the Settlement Administrator of the notice of the denial of the Claim. The Contest Notice procedures final determination letters shall notify Claimants that they are entitled to appeal the determination at no additional cost. Claimants who accept an initial determination, i.e., by communicating acceptance or not making a cure attempt, shall not be posted on eligible to appeal the Settlement Website and shall also be provided in writing to any Settlement Class Member whose Claim is deniedfinal determination. 4.20 Within sixty (60) days after 3. In processing claims made by Claimants for Total Loss, the Settlement Class Member mails the Contest NoticeSettlement 4. For Claims that meet all requirements, the Settlement Administrator shall consider also determine the claimant’s request for reconsideration and any materials submitted by the Settlement Class Member in support thereof, and mail to the Settlement Class Member a final determination maximum amount of the Claimreimbursement under the Common Fund. The decision Following 90 days after the end of the claims period (and subject to reasonable extensions agreed to by Class Counsel depending on Claims volume), the Settlement Administrator shall be final unless report to Defendants and Class Counsel the Settlement total amount and number of approved Claims. If the total Claims fall below the $80 million Common Fund floor (inclusive of Class Member submits the denied Claim Counsel’s attorneys’ fees, costs, and expenses), Class Counsel shall confer with Defendants to the National Center for Dispute Settlement for resolution as described in paragraph 4.21 below. 4.21 If provide guidance to the Settlement Administrator finally denies a Claimas to the pro rata increase in payments to be made to the Claimants. 5. Within 120 days after the end of the claims period (or, if the total Claims fall below the $80 million Common Fund floor (inclusive of Class Counsel’s attorneys’ fees, costs, and expenses)), and within 60 days of receipt of guidance from Class Counsel as to the pro rata increase in payments to be made to the Claimants), the Settlement Class Member may appeal Administrator shall notify the denial Claimant of its final determination as to the National Center for Dispute Settlement for binding resolution in accordance payment owed under the Common Fund. 6. Defendants and Class Counsel shall have the right, but no obligation, to review and comment on all claims submissions, determinations, and appeals, obtain information and documents necessary to the administration of Claims and appeals, and confer with the terms and conditions of the NVLW that accompanied the Settlement Class Vehicle at the original point of sale or lease, except that any such appeal must be filed within ninety (90) days of final denial by the Settlement Administrator regarding determinations of claims and appeals. To ensure no Class member is paid twice for the same Claim, Defendants shall have the right to receive and review the list of approved Claims and corresponding VIN and Claimant information before the Settlement Administrator gives notice of its initial determination. Defendants shall also have the right to submit any decision by the National Center for Dispute Settlement will be final and binding upon all parties. AHM will pay documentation, such as any cost charged by the National Center for Dispute Settlement for resolving the dispute. Each party shall be responsible for paying hisprior releases, herpayments, or its own attorneys’ fees and other expenses if hesteering wheel lock records, sheetc., or it decides to retain counsel. 4.22 By no later than one hundred and twenty (120) days after the Effective Date, AHM will provide to Settlement Class Members who timely filed valid Claims the Benefit and/or out- of-pocket expense reimbursement (as applicable). 4.23 If this settlement never becomes Final for any reason, no relief, Benefit, Extended Warranty or reimbursement of any kind shall be made to anyone pursuant to the Settlement AgreementAdministrator for review in connection with processing a Claim to ensure that no Class member is paid twice for the same Claim.

Claims Processing. 4.16 Within reasonable time of receiving a Claim Form and any accompanying documentation, the The Settlement Administrator will review shall apply the documentation and/or AHM’s records terms of this Settlement Agreement and either confirm or deny the Settlement Class Member’s eligibility for the Benefit and/or out-of-pocket expense reimbursement (as applicable). 4.17 If the determination is to deny a Claim, the Settlement Administrator will send, within sixty (60) days after determination of denial, notice of the denial to the Settlement Class Member. Such notice will set forth the reason(s) for the denial and provide notice of the claimant’s right to contest the denial and request reconsideration and/or to attempt to cure any defect within thirty (30) days. On a quarterly basis after the Effective Date until all Claims have been processed, the Settlement Administrator will provide to Class Counsel a list of all Claims that have been denied, along with the Claim Forms and supporting documentation and other relevant information relating to the denial with appropriate PII redactions. 4.18 Claims that do not meet the requirements set forth in the Claim Form in processing all Claim Forms that are submitted. KCC shall determine, in the first instance, whether a Class Member has submitted a valid and timely Claim Form. The Settlement Agreement Administrator also shall be deniedemploy reasonable procedures to screen claims for abuse, fraud, or duplication, and shall promptly make Defense Counsel and Class Counsel aware of any evidence of abuse, fraud, or duplication. Grounds Counsel for rejection includethe Parties will have 14 days from the date that KCC informs the Parties of the total number of valid and approved claims submitted to dispute any Approved Claim, but are not limited to, failure and to provide Proof of Expenses or any other required information, untimely submission of the Claim Form, or submission of ineligible repair expenses. 4.19 A Settlement Class Member whose Claim has been denied may attempt to cure the deficiency or contest the decision denying the Claim by mailing its reasoning for dispute in writing to the Settlement Administrator at Administrator. The ultimate determination of whether to reject or accept the mailing address claim will be made by KCC. The Parties, the Released Parties, and their respective counsel shall have no responsibility or liability whatsoever for the administration Settlement Administrator’s conduct, omissions, or actions. KCC may assist class members in the completion of this SettlementClaim Forms and is empowered to respond to class members’ inquiries for that purpose. If KCC rejects a claim for any reason other than timeliness, it will provide the proof of claim form and reason for rejection to Class Counsel and counsel for Defendants. Counsel for the Parties will have 14 days to dispute the reasons for the rejection, and to provide its reasoning for dispute in writing to the Settlement Administrator. The ultimate determination of whether to reject or accept the claim will be made by KCC. If a Claim Form is deficient, KCC shall notify the Claimant and identify the reason(s) for the deficiency. The claimant must either correct any error identified and re-file, or, if he wishes to dispute the rejection, must submit a signed, written notice containing information to attempt to cure any claim deficiencies or a statement of reasons the Settlement Class Member contests the denial, along with any additional supporting documentation (the “Contest Notice”)contesting KCC’s determination. Any Contest Notice That written contest must be submitted and postmarked within thirty (30) 14 days after from the postmark date of mailing by the Settlement Administrator of the notice of the denial of the Claimdeficiency letter and mailed to KCC. The Contest Notice procedures shall be posted on the Settlement Website and shall also be provided in writing to any Settlement Class Member whose Claim is denied. 4.20 Within sixty (60) days after the Settlement Class Member mails the Contest Notice, the Settlement Administrator shall consider the claimant’s request for reconsideration and any materials submitted by the Settlement Class Member in support thereof, and mail to the Settlement Class Member a final determination of the Claim. The decision of the Settlement Administrator shall be final unless the Settlement Class Member submits the denied Claim to the National Center for Dispute Settlement for resolution as described in paragraph 4.21 below. 4.21 If the Settlement Administrator finally denies a Claim, the Settlement Class Member may appeal the denial to the National Center for Dispute Settlement for binding resolution in accordance with the terms and conditions of the NVLW that accompanied the Settlement Class Vehicle at the original point of sale or lease, except that any such appeal must be filed within ninety (90) days of final denial by the Settlement Administrator and any decision by the National Center for Dispute Settlement will be final and binding upon all parties. AHM will pay any cost charged by the National Center for Dispute Settlement for resolving the dispute. Each party shall be responsible for paying his, her, or its own attorneys’ fees and other expenses if he, she, or it decides left to retain counselKCC. 4.22 By no later than one hundred and twenty (120) days after the Effective Date, AHM will provide to Settlement Class Members who timely filed valid Claims the Benefit and/or out- of-pocket expense reimbursement (as applicable). 4.23 If this settlement never becomes Final for any reason, no relief, Benefit, Extended Warranty or reimbursement of any kind shall be made to anyone pursuant to the Settlement Agreement.

Claims Processing. 4.16 Within reasonable time 1. Upon receipt of receiving a Claim Form and any accompanying documentation, the Settlement Administrator will review the documentation and/or AHM’s records and either confirm or deny the Settlement Class Member’s eligibility for the Benefit and/or out-of-pocket expense reimbursement (as applicable). 4.17 If the determination is to deny a Claim, the Settlement Administrator will sendshall review the Claim to determine whether the Claim meets all qualifications for payment set forth in this Settlement Agreement and shall notify Claimants who do not meet all qualifications. Within 60 days of receiving the Claim, within sixty (60) days after determination of denial, notice of the denial to the Settlement Class Member. Such notice will set forth administrator shall notify the reason(s) Claimant of: a. Any deficiency in required documentation and shall reasonably specify what documents and/or information, if any, are still needed for claims determination; b. The basis for the denial and provide notice of Settlement Administrator’s decision to deny a Claim, including the claimantspecific deficiencies in the Claim’s supporting documentation, if any; c. The Claimant’s right to contest the denial and request reconsideration and/or to attempt to cure any defect deficiency, including any deficiency that led to the Settlement Administrator’s denial of a Claim; and d. The initial determination of the amount owed for a Claim and/or notice that any determination as to Claims for payments from the Common Fund are going to be processed at the end of the claims period. 2. In response to receiving the written notice under section III.C.1, Claimants may: a. Attempt to cure the deficiency stated as justification for denying a Claim, by submitting the information and/or documentation identified by the Settlement Administrator as lacking in the Claim, within thirty (30) days45 days of receipt of the written notice. On a quarterly basis after The Settlement Administrators shall have 45 days from the Effective Date until all Claims have been processeddate of receiving the cure attempt to provide written notice to the Claimant stating its final determination as to the approval or denial of the Claim, and shall notify the Claimant that they are entitled to appeal the determination to the Settlement Administrator at no additional cost; or b. Accept the initial determination by the Settlement Administrator, which acceptance will be presumed if no cure attempt is received by the Settlement Administrators within 45 days of the date of the initial determination, at which point the Settlement Administrator will provide to Class Counsel a list of all Claims that have been denied, along Claimants with the Claim Forms and supporting documentation and other relevant information relating their final determination as to the denial with appropriate PII redactions. 4.18 Claims that do not meet the requirements set forth in the Settlement Agreement shall be denied. Grounds for rejection include, but are not limited to, failure to provide Proof of Expenses approval or any other required information, untimely submission of the Claim Form, or submission of ineligible repair expenses. 4.19 A Settlement Class Member whose Claim has been denied may attempt to cure the deficiency or contest the decision denying the Claim by mailing to the Settlement Administrator at the mailing address for the administration of this Settlement, written notice containing information to attempt to cure any claim deficiencies or a statement of reasons the Settlement Class Member contests the denial, along with any additional supporting documentation (the “Contest Notice”). Any Contest Notice must be postmarked within thirty (30) days after the date of mailing by the Settlement Administrator of the notice of the denial of the Claim. The Contest Notice procedures final determination letters shall notify Claimants that they are entitled to appeal the determination at no additional cost. Claimants who accept an initial determination, i.e., by communicating acceptance or not making a cure attempt, shall not be posted on eligible to appeal the Settlement Website and shall also be provided in writing to any Settlement Class Member whose Claim is deniedfinal determination. 4.20 Within sixty (60) days after the Settlement Class Member mails the Contest Notice3. For Claims that meet all requirements, the Settlement Administrator shall consider also determine the claimant’s request for reconsideration and any materials submitted by the Settlement Class Member in support thereof, and mail to the Settlement Class Member a final determination maximum amount of the Claimreimbursement under the Common Fund. The decision Following 90 days after the end of the claims period (and subject to reasonable extensions agreed to by Class Counsel depending on Claims volume), the Settlement Administrator shall be final unless report to Defendants and Class Counsel the Settlement total amount and number of approved Claims. If the total Claims fall below the $80 million Common Fund floor (inclusive of Class Member submits Counsel’s attorneys’ fees, costs, and expenses and the denied Claim $10 million credit to Defendants if the National Center for Dispute Settlement for resolution as described in paragraph 4.21 below. 4.21 If total Claims equal or do not exceed $50 million), Class Counsel shall confer with Defendants to provide guidance to the Settlement Administrator finally denies a Claimas to the pro rata increase in payments to be made to the Claimants. 4. Within 120 days after the end of the claims period (or, if the total Claims fall below the $80 million Common Fund floor (inclusive of Class Counsel’s attorneys’ fees, costs, and expenses and the $10 million credit to Defendants if the total Claims equal or do not exceed $50 million)), and within 60 days of receipt of guidance from Class Counsel as to the pro rata increase in payments to be made to the Claimants), the Settlement Class Member may appeal Administrator shall notify the denial Claimant of its final determination as to the National Center for Dispute Settlement for binding resolution in accordance payment owed under the Common Fund. 5. Defendants and Class Counsel shall have the right, but no obligation, to review and comment on all claims submissions, determinations, and appeals, obtain information and documents necessary to the administration of Claims and appeals, and confer with the terms and conditions of the NVLW that accompanied the Settlement Class Vehicle at the original point of sale or lease, except that any such appeal must be filed within ninety (90) days of final denial by the Settlement Administrator regarding determinations of claims and appeals. To ensure no Class member is paid twice for the same Claim, Defendants shall have the right to receive and review the list of approved Claims and corresponding VIN and Claimant information before the Settlement Administrator gives notice of its initial determination. Defendants shall also have the right to submit any decision by the National Center for Dispute Settlement will be final and binding upon all parties. AHM will pay documentation, such as any cost charged by the National Center for Dispute Settlement for resolving the dispute. Each party shall be responsible for paying hisprior releases, herpayments, or its own attorneys’ fees and other expenses if hesteering wheel lock records, sheetc., or it decides to retain counsel. 4.22 By no later than one hundred and twenty (120) days after the Effective Date, AHM will provide to Settlement Class Members who timely filed valid Claims the Benefit and/or out- of-pocket expense reimbursement (as applicable). 4.23 If this settlement never becomes Final for any reason, no relief, Benefit, Extended Warranty or reimbursement of any kind shall be made to anyone pursuant to the Settlement AgreementAdministrator for review in connection with processing a Claim to ensure that no Class member is paid twice for the same Claim.