Common use of OBLIGATIONS OF THE INSURER Clause in Contracts

OBLIGATIONS OF THE INSURER. The Insurer is bound to enable the Insured to exercise his/her rights provided under the Agreement on voluntary health insurance, as well as the rights defined in these General Terms and Conditions and Special Terms and Conditions. In line with the Insurance Agreement, i.e. Policy and Special Terms and Conditions, the Insurer is required to compensate a healthcare service provider or the Insured for treatment costs or a part thereof incurred due to exercising the rights under the contracted voluntary health insurance, as well as the agreed amount of pecuniary compensation, within 14 days as of the date when received complete documentation based on which the indisputable existence and scope of liability can be established. The Sum Insured specified in the Policy represents the top limit of the Insurer's obligation under the Insurance Agreement. The Insurer is entitled to request from the Insured, Policyholder or any other legal or physical entity to provide additional explanations or additional documentation in order to establish important circumstances relevant for the reported Insured Event. The Insurer is entitled to refer the Insured to a control medical examination or additional medical evaluation, by which necessary circumstances relevant for the reported insured event would be established. The costs of such evaluations are borne by the Insurer.