Common use of Notice and Proof of Claim Clause in Contracts

Notice and Proof of Claim. In the event of a request for payment, the participant or the insured person must present his or her claim to the insurer while coverage is in force, accompanied by all the supporting documentation considered necessary by the insurer, within the 12 months following the date that the expenses were incurred. Eligible expenses are reimbursed or paid out within 30 days after receipt of the claim accompanied by all the necessary supporting documentation. (new x-ray, photos, study models should be sent before treatment is rendered) The participant or the insured person who disagrees with a decision of the insurer may request a review within 30 days following this decision by sending a written request to the insurer and adding any new supporting documentation. No request for a review will be considered if it is received more than 12 months after the insurer’s original decision. Claims payments after your policy ends: We must receive your claim within 90 days of the date your coverage or policy ended. We will not pay for any claims received by us more than 90 days after the date your policy ended, regardless of when the eligible expense was incurred.