Coverage Issues Sample Clauses

Coverage Issues. General Agent may refer any coverage question, denial of liability, or Policy limit demand to Company for final determination by Company concerning such issues. General Agent shall notify and provide a copy of any applicable claim file to Company within 30 days of determination that a claim has: (a) the potential to exceed the authority limit set forth in Article 21.2 of this Agreement; (b) a coverage dispute, or any unusual circumstances or large loss possibilities or any issues that would be required to be reported to Reinsurers under the Affiliated Reinsurance Agreements, Quota Share Reinsurance Agreement, or Excess of Loss Reinsurance Agreement; (c) a demand in excess of Policy limits; (d) allegations of bad faith, violations of any deceptive trade practice acts, or any other Regulation; (e) resulted in a legal action being instituted against General Agent, an Agent, a Broker or Company; (f) arisen from or caused a complaint to be filed with any regulatory authority; (g) arisen from or caused an inquiry from any regulatory authority, including, but not limited to, any insurance department, with respect to any loss, even if the inquiry does not arise from a complaint; Managing General Agency Agreement Effective July 1, 2006 (h) a significant coverage dispute that may be denied; (j) been open for more than six months or involves an allegation of extra contractual damages;
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Coverage Issues. SRM administers IDPN therapy to chronic dialysis patients who suffer from severe gastrointestinal malfunctions. IDPN therapy was provided by Homecare prior to its divestiture. After 1993, Medicare claims processors sharply reduced the number of IDPN claims approved for payment as compared to prior periods. NMC believes that the reduction in IDPN claims represented an unauthorized policy coverage change. Accordingly, NMC and other IDPN providers pursued various administrative and legal remedies, including administrative appeals, to address this reduction. In November 1995, NMC filed a complaint in the U.S. District Court for the Middle District of Pennsylvania seeking a declaratory judgment and injunctive relief to prevent the implementation of this policy coverage change. (National Medical Care, Inc. v. Shalala, 3:CV-95-1922 (RPC)). Subsequently, the District Court affirmed a prior report of the magistrate judge dismissing NMC’s complaint, without considering any substantive claims, on the grounds that the underlying cause of action should be submitted fully to the administrative review processes available under the Medicare Act. NMC decided not to appeal the Court’s decision, but rather, to pursue the claims through the available administrative processes. NMC was successful in pursuing these claims through the administrative process, receiving favorable decisions from Administrative Law Judges in more than 80% of its cases. In early 1998, a group of claims which had been ruled on favorably were remanded by the Medicare Appeals Council to a single Administrative Law Judge (the “ALJ”) with extensive instructions concerning the review of these decisions. A hearing was scheduled on the remanded claims to take place in July, but later postponed until October 1998. Prior to the July hearing date, the United States Attorney for the District of Massachusetts requested that the hearing be stayed pending resolution of the OIG Investigation, on the basis that proceeding could adversely effect the government’s investigation as well as the government’s efforts to confirm its belief that these claims are false. Prior to the ALJ issuing a decision on the stay request, the U.S. Attorney’s Office requested that NMC agree to a stay in the proceedings in order to achieve a potential resolution of the IDPN claims subject to the OIG Investigation as well as those which are subject to the administrative appeals process. NMC agreed to this request, and together with the U.S. At...
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Coverage Issues. This plan only covers Amish workers. It does not cover non-Amish workers. An Amish employer may employ both Amish workers and non-Amish workers. Accordingly, if such an Amish employer participates in the Amish Small Business Aid plan, it must still provide coverage for its non-Amish workers. For an insurer covering such an employer, to properly set up the policy, it appears an appropriate method could be attaching the Partners, Officers and Others Exclusion Endorsement (WC 00 03 08). In the endorsement schedule of excluded workers, it could display the words “Amish employees covered under the Amish Small Business Aid.” Because this agreement is new, and in consultation with the Board, we have attempted to anticipate issues and questions which may arise and provided answers (please see below).
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Coverage Issues. General Agent may refer any coverage question, denial of liability, or Policy limit demand to Company for final determination by Company concerning such issues. General Agent shall notify and provide a copy of any applicable claim file to Company within 30 days of determination that a claim has: (a) the potential to exceed the authority limit set forth in Article 21.2 of this Agreement; (b) a coverage dispute, or any unusual circumstances or large loss possibilities or any issues that would be required to be reported to Reinsurers under the Affiliated Reinsurance Agreements, Quota Share Reinsurance Agreement, or Excess of Loss Reinsurance Agreement; (c) a demand in excess of Policy limits; (d) allegations of bad faith, violations of any deceptive trade practice acts, or any other Regulation; (e) resulted in a legal action being instituted against General Agent, an Agent, a Broker or Company; (f) arisen from or caused a complaint to be filed with any regulatory authority; (g) arisen from or caused an inquiry from any regulatory authority, including, but not limited to, any insurance department, with respect to any loss, even if the inquiry does not arise from a complaint; 25 Managing General Agency Agreement Effective July 1, 2006 (h) a significant coverage dispute that may be denied; (j) been open for more than six months or involves an allegation of extra contractual damages; (j) a minor claimant, unless it is certain that the amount of the loss related to a minor is less than $[**]; or (k) been closed by payment of an amount established by Company. General Agent shall, if requested by Company, send a copy of each and every claim to Company within 24 hours of General Agent’s receipt of such claim as described in Article 21.2 of this Agreement. To the extent possible, such transmission of claims shall be by electronic means, overnight mail or facsimile to Company at 0-000-000-0000 or such other telephone number as Company may specify. 21.
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Coverage Issues 
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Related to Coverage Issues

  • Fire and Extended Coverage Insurance (a) Tenant shall keep the Premises and all leasehold improvements installed in the Premises by the Tenant (and all of Tenant's Trade Fixtures and Equipment, Tenant's merchandise, furnishings, equipment, personal property and plate glass, Tenant's wall covering, floor covering, carpeting and drape, and fixtures and equipment installed by Tenant) insured against loss or damage by fire, with the usual extended coverage and all risk endorsements, including flood and earthquake, in amounts not less than the full insurable, replacement value thereof above foundations. Tenant shall also obtain rental interruption insurance for the benefit of the Landlord. Landlord shall be named as an additional insured on said policy using ISO Form 20-26. (b) If Tenant fails to obtain or maintain the policy required by section 10.1 (a) above, this shall be considered an Event of Default under this Lease which must be cured upon three (3) days written notice. In the event Tenant fails to maintain the insurance provided for herein, Landlord may obtain such policy and in such event, Tenant agrees to pay Landlord, as Additional Rent, all such insurance premiums separately assessed against the Premises or Tenant's Allocable Share, if such insurance is contained in a blanket policy covering the Shopping Center, as computed under Section "12.3", of any such insurance premiums for the Premises as computed under Section "12.3", as estimated by Landlord. In addition, Tenant shall pay to Landlord its Allocable Share of such premiums relating to the Common Areas, within twenty (20) days after Tenant receives a bxxx for such premium from the Landlord. For the insurance years in which this Lease commences and terminates, the provisions of this paragraph shall apply and Tenant's liability for its Allocable Share of any insurance for such year shall be subject to a pro-rata adjustment based on the number of days of said year(s) during which the term of this Lease was in effect.

  • Coverage Limits By requiring insurance, the State of Washington and DSHS do not represent that the coverage and limits required in this Contract will be adequate to protect the Contractor. Such coverage and limits shall not limit the Contractor’s liability in excess of the required coverage and limits, and shall not limit the Contractor’s liability under the indemnities and reimbursements granted to the State and DSHS in this Contract.

  • Coverage Minimum Limits Commercial General Liability $1,000,000 per occurrence $2,000,000 aggregate Automobile Liability including coverage for owned, non-owned and hired vehicles $1,000,000 per occurrence

  • Coverage If any of the aforementioned liability insurance is arranged on a "claims made" basis, "tail" coverage will be required at the completion of this contract for a duration of 24 months or the maximum time period the PURCHASER's insurer will provide such if less than 24 months. PURCHASER will be responsible for furnishing certification of "tail" coverage as described or continuous "claims made" liability coverage for 24 months following contract completion. Continuous "claims made" coverage will be acceptable in lieu of "tail" coverage, provided its retroactive date is on or before the effective date of this contract.

  • Coverage Term All insurance required herein shall be maintained in full force and effect until all work or services required to be performed under the terms of this Agreement are satisfactorily performed, completed and formally accepted by the City, unless specified otherwise in this Agreement.

  • General Liability Coverage The CONTRACTOR shall maintain commercial general liability insurance in an amount of not less than one million dollars ($1,000,000) per occurrence for bodily injury, personal injury, and property damage. If a commercial general liability insurance form or other form with a general aggregate limit is used, either the general aggregate limit shall apply separately to the work to be performed under this Agreement or the general aggregate limit shall be at least twice the required occurrence limit.

  • Maintenance of Hazard Insurance and Errors and Omissions and Fidelity Coverage (a) The Servicer shall cause to be maintained for each Mortgage Loan fire insurance with extended coverage on the related Mortgaged Property in an amount which is at least equal to the least of (i) the outstanding principal balance of such Mortgage Loan, (ii) the amount necessary to fully compensate for any damage or loss to the improvements that are a part of such property on a replacement cost basis and (iii) the maximum insurable value of the improvements which are a part of such Mortgaged Property, in each case in an amount not less than such amount as is necessary to avoid the application of any coinsurance clause contained in the related hazard insurance policy. The Servicer shall also cause to be maintained fire insurance with extended coverage on each REO Property in an amount which is at least equal to the lesser of (i) the maximum insurable value of the improvements which are a part of such property and (ii) the outstanding principal balance of the related Mortgage Loan at the time it became an REO Property, plus accrued interest at the Mortgage Rate and related Servicing Advances. The Servicer will comply in the performance of this Agreement with all reasonable rules and requirements of each insurer under any such hazard policies. Any amounts to be collected by the Servicer under any such policies (other than amounts required to be deposited in the Escrow Account and applied to the restoration or repair of the property subject to the related Mortgage or amounts to be released to the Mortgagor in accordance with the procedures that the Servicer would follow in servicing loans held for its own account, subject to the terms and conditions of the related Mortgage and Mortgage Note) shall be deposited in the Collection Account, subject to withdrawal pursuant to Section 3.11. Any cost incurred by the Servicer in maintaining any such insurance shall not, for the purpose of calculating distributions to the Trustee, be added to the unpaid principal balance of the related Mortgage Loan, notwithstanding that the terms of such Mortgage Loan so permit. It is understood and agreed that no earthquake or other additional insurance is to be required of any Mortgagor other than pursuant to such applicable laws and regulations as shall at any time be in force and as shall require such additional insurance. If the Mortgaged Property or REO Property is at any time in an area identified in the Federal Register by the Federal Emergency Management Agency as having special flood hazards and flood insurance has been made available, the Servicer will cause to be maintained a flood insurance policy in respect thereof. Such flood insurance shall be in an amount equal to the lesser of (i) the unpaid principal balance of the related Mortgage Loan and (ii) the maximum amount of such insurance available for the related Mortgaged Property under the national flood insurance program (assuming that the area in which such Mortgaged Property is located is participating in such program). In the event that the Servicer shall obtain and maintain a blanket policy with an insurer either (i) acceptable to Fannie Mae or Freddie Mac or (ii) having a general policy rating of A:VX xx xexxxr in Xxxx'x (or such other rating that is comparable to such rating) insuring against hazard losses on all of the Mortgage Loans, it shall conclusively be deemed to have satisfied its obligations as set forth in the first two sentences of this Section 3.13, it being understood and agreed that such policy may contain a deductible clause, in which case the Servicer shall, in the event that there shall not have been maintained on the related Mortgaged Property or REO Property a policy complying with the first two sentences of this Section 3.13, and there shall have been one or more losses which would have been covered by such policy, deposit to the Collection Account from its own funds the amount not otherwise payable under the blanket policy because of such deductible clause. In connection with its activities as administrator and servicer of the Mortgage Loans, the Servicer agrees to prepare and present, on behalf of itself and the Trustee, claims under any such blanket policy in a timely fashion in accordance with the terms of such policy. (b) The Servicer shall keep in force during the term of this Agreement a policy or policies of insurance covering errors and omissions for failure in the performance of the Servicer's obligations under this Agreement, which policy or policies shall be in such form and amount that would meet the requirements of Fannie Mae or Freddie Mac if it were the purchaser of the Mortgage Loanx. Xxx Servicex xxxxx also maintain a fidelity bond in the form and amount that would meet the requirements of Fannie Mae or Freddie Mac, unless the Servicer has obtained a waiver of xxxx requiremxxxx xxom Fannie Mae or Freddie Mac. The Servicer shall provide the Trustee upon xxxxxxt with cxxxxx xf any such insurance policies and fidelity bond. The Servicer shall be deemed to have complied with this provision if an Affiliate of the Servicer has such errors and omissions and fidelity bond coverage and, by the terms of such insurance policy or fidelity bond, the coverage afforded thereunder extends to the Servicer. Any such errors and omissions policy and fidelity bond shall by its terms not be cancelable without thirty days' prior written notice to the Trustee. The Servicer shall also cause each Subservicer to maintain a policy of insurance covering errors and omissions and a fidelity bond which would meet such requirements.

  • Life Insurance Coverage a. Forty Thousand ($40,000) Dollars life insurance policy with AD&D from an insurance carrier selected by the Board, subject to the provisions of this section. b. Employees who have Board-provided term life insurance shall have a thirty- one (31) day conversion right upon termination of employment. Any employee electing the right to conversion in order to keep term life insurance in force, must contact the insurance carrier within thirty-one (31) days of the last day of employment. c. The life insurance policy shall pay to the employee’s beneficiary the aforementioned sum within the underwriting rules and regulations as set forth by the insurance carrier.

  • Required Insurance Coverage As a condition of this Contract with DIR, Vendor shall provide the listed insurance coverage within 5 business days of execution of the Contract if the Vendor is awarded services which require that Vendor’s employees perform work at any Customer premises and/or use employer vehicles to conduct work on behalf of Customers. In addition, when engaged by a Customer to provide services on Customer premises, the Vendor shall, at its own expense, secure and maintain the insurance coverage specified herein, and shall provide proof of such insurance coverage to the related Customer within five (5) business days following the execution of the Purchase Order. Vendor may not begin performance under the Contract and/or a Purchase Order until such proof of insurance coverage is provided to, and approved by, DIR and the Customer. All required insurance must be issued by companies that have an A rating and a Financial Size Category Class of VII from A.M. Best, and are licensed in the State of Texas and authorized to provide the corresponding coverage. The Customer and DIR will be named as Additional Insureds on all required coverage. Required coverage must remain in effect through the term of the Contract and each Purchase Order issued to Vendor there under. The minimum acceptable insurance provisions are as follows:

  • Commercial Umbrella Liability Insurance The Contractor shall provide a Commercial Umbrella Liability Insurance to provide excess coverage above the Commercial General Liability, Commercial Business Automobile Liability and the Workers' Compensation and Employers' Liability to satisfy the minimum limits set forth herein. The umbrella coverage shall follow form with the Umbrella limits required as follows: $ 2,000,000 per Occurrence $2,000,000 per Occurrence $ 4,000,000 Aggregate $10,000,000 Aggregate Additional Requirements for Commercial Umbrella Liability Insurance are shown below at Paragraph 1.5.3.3.6.

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