HOW TO SUBMIT A CLAIM. If You have a claim, please contact Our Administrator by mail at P.O. Box 1910, Arlington Heights, IL 00000-0000, by phone at (000) 000-0000, or via fax (000) 000-0000. You must provide Our Administrator with the Lessor’s itemized statement detailing the repairs or replacements required or Excess Wear & Use charges You are responsible for, and such other documentation as Our Administrator may request. You must file Your claim within thirty (30) days after receiving the Lessor’s itemized statement, or Your claim may be denied. Our Administrator reserves the right to conduct their own inspection of the Vehicle or require photographs of the Excess Wear & Use which is the subject of Your claim. The requirements set forth herein are in addition to any other Finance Agreement requirements.
HOW TO SUBMIT A CLAIM. 1. Contact or have a representative of the repair facility contact ADMINISTRATOR’S Claim Department BEFORE any work is performed by calling (000) 000-0000.
2. Upon diagnosis and determination of covered items, subject to the terms and conditions of this CONTRACT, ADMINISTRATOR will issue an authorization number. The authorization number MUST appear on all repair bills. Failure to obtain authorization PRIOR TO REPAIRS will result in non-payment of claim. Fraudulent or misuse of this CONTRACT will result in non-payment of claim and cancellation of this CONTRACT. ADMINISTRATOR RESERVES THE RIGHT TO INSPECT ALL VEHICLES PRIOR TO OR AFTER REPAIRS ARE PERFORMED.
3. For emergency repairs, should a BREAKDOWN occur after the ADMINISTRATOR’S normal business hours or on a national holiday, the pre-authorization requirement is amended. The ADMINISTRATOR must still be contacted when reasonably possible following the BREAKDOWN. Such unauthorized repair claims will be subject to adjustment in cases of excessive parts or labor charges. The labor cost to be determined by a flat rate labor manual (i.e. Xxxxxxx) multiplied by the customary labor charge for the repair/replacement of a protected part. The labor rate allowed shall not exceed the national average labor rate.
4. Upon the filing of a claim under this CONTRACT, ADMINISTRATOR will verify the validity of the CONTRACT (proper owner, proper vehicle, CONTRACT still in force), verify the BREAKDOWN with the Repair Facility, verify coverage, and authorize repair of COVERED PARTS (provide Repair Facility with authorization code and confirm cost of repair). Payment is provided through direct billing, credit card, or CONTRACT HOLDER reimbursement.
HOW TO SUBMIT A CLAIM. All claim forms, available from your Plan Administrator, must be correctly completed, dated and signed. Remember, always provide your Group Policy Number and your Certificate Number (found on your Group Benefit Card) to avoid any unnecessary delays in the processing of your claim. Your Plan Administrator can assist you in properly completingthe forms, and answer any questions you may have about the claims process and your Group Benefit Program.
HOW TO SUBMIT A CLAIM i. Claims for Benefits must be filed on a standard Claim Form that is available in most dental offices. PPO and Premier Providers will fill out and submit your claims paperwork for you. Some Non-Delta Dental Providers may also provide this service upon your request. If you receive services from a Non-Delta Dental Provider who does not provide this service, you can submit your own claim directly to the dental plan. Please refer to the section titled “Dental Claim Form” for more information.
ii. Your dental office should be able to assist you in filling out the Claim Form. Fill out the Claim Form completely and send it to: Delta Dental P.O. Box 1809 Alpharetta, GA 00000-0000 000-000-0000 fax
HOW TO SUBMIT A CLAIM. 4.1 A Claim to receive services under this Plan must be submitted directly to Us, within 14 days of the occurrence of the accidental stain or accidental damage to the Covered Product covered by this Plan. You may contact Us by telephone at 0.000.000.0000 during normal business hours or by submitting a Claim at xxxxxxx.xxxxxxxxxx.xxx.
4.2 To assist Us in providing the best solution for You, We may request photos of the stained or damaged area of the Covered Product(s). We may, at Our discretion, deliver a cleaning product to You to assist with removal of the reported stain.
4.3 Please note that Claims will only be considered and are subject to the following conditions:
4.a Your Plan has been activated prior to submitting a Claim or requesting service.
4.b You provide Us with a copy of the original Sales Receipt, the Plan Activation Code and the Retailer ID (which can be found on the SmartOne Activation Card).
4.c The Covered Products were delivered to You stain-free and damage-free.
4.d Any attempt to repair or clean the Covered Product is performed only as directed by Us.
HOW TO SUBMIT A CLAIM. All claim forms, available from your Plan Administrator, must be correctly completed, How to Submit a Claim dated and signed. Remember, always provide your Group Policy Number and your Certificate number (found on your Group Benefit Card) to avoid any unnecessary delays in the processing of your claim. Your Plan Administrator can assist you in properly completing the forms, and answer any questions you may have about the claims process and your Group Benefit Program. After completing the appropriate form, mail your Extended HealthCare and Dental claims directly to Manulife Financial.
HOW TO SUBMIT A CLAIM. Benefits under this creditor insurance are payable to the Lender. In the event of a claim, You or Your representative must notify Us or the Lender within 30 days at the address or telephone number set out below. We or the Lender will send You or Your representative a claim form and instructions on submitting a claim with proof of loss. Any costs for the completion of a claim form or any documentation submitted in support of a claim are at You or Your representative’s expense. In the event of a death claim, We have the right, where allowed by law, to ask for an autopsy. In the event of an Involuntary Unemployment Insurance Benefit claim, We have the right to request information from Your former employer. Benefits will not be paid if You or Your representative refuse to provide a claim form or any documentation that is, or may be, reasonably required in support of a claim. You or Your representative must provide Us with the completed claim forms and written proof of the claim within 90 days of Your death, Your diagnosis of Covered Critical Illness, Your Involuntary Unemployment or Your Injury or Sickness. Failure to give Us notice of claim or provide Us with satisfactory proof of Your claim within this 90 day period does not invalidate the claim if the notice or proof is given by Your or Your representative as soon as reasonably possible, but in no event later than one year from the date of Your death, Your diagnosis of Covered Critical Illness, or Your Involuntary Unemployment if it is shown that it was not reasonably possible to give notice or provide proof within this one year period. You can contact Us at the following address or telephone number: 00000 – 000 Xxxxxx XX Edmonton, Alberta, T5M 3S2 1-844-930-6022
HOW TO SUBMIT A CLAIM. If the Covered Person is covered by Social Security, Medicare, or another insurance policy (private or not) he must obtain the reimbursement to which he is entitled before filing the claim. Statement of Social Security or other reimbursement and all medical bills relating to the claim must be enclosed (copies are acceptable only if the original statement of Social Security reimbursement is enclo- sed). The claim form must be submitted to the Insurer. In no case will the total of the refunds (this insurance contract plus Social Security or any other plan) ex- ceed the actual expense. Medical claims must be presented within ONE YEAR from the date the expenses are incurred.
HOW TO SUBMIT A CLAIM. In order to process a Annual Distribution Policy claim for reimbursement for any given year you must submit an application to CGIFN no later than October 15th of the fiscal year of CGIFN (commencing October 15, 2013), along with your name, birth date, current address, telephone number, where you can be reached and status number (include a copy of your status card). Payments claimed for minor Members by a parent or guardian must be accompanied by the appropriate documentation, including proof of legal custody in certain circumstances.
HOW TO SUBMIT A CLAIM. The executor, or estate trustee, named in the will of the deceased Member’s may apply for the funds. If the Member left no will, then anyone appointed by a court of competent jurisdiction to manage the affairs of the deceased Member may apply for the funds. If the Member left no will and no one has been appointed by a court of competent jurisdiction to manage the affairs of the deceased Member, then the surviving spouse or closest next of kin may apply.
