Common use of Notice and Proof of Claim Clause in Contracts

Notice and Proof of Claim. The insured person or any other person acting on his or her behalf must advise the insurer within 24 hours of the accident or illness that resulted in eligible expenses under this coverage or, if unable to do so, as soon as possible thereafter. 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 12 months following the date that the expenses were incurred, or that request will not be accepted. Eligible expenses are reimbursed or paid out within 30 days after receipt of the claim accompanied by all the necessary supporting documentation. The participant or the insured person who disagrees with a decision of the insurer may request a review within the 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.