Common use of Proof of Claim Clause in Contracts

Proof of Claim. The insured must pro- vide written proof of loss consisting of original itemized bills, medical records, and a claim form properly completed and signed to USA Medical Services at 00000 Xxx Xxxxxx Xxxx, Suite 400, Palmetto Bay, Florida 33157, within one hundred eighty (180) days after the treatment or service date. Failure to do so may result in the claim being denied. A completed claim form per incident is required for all claims submit- xxx. For claims related to car accidents, the following additional documentation is required for review: police reports, first insurance proof of coverage, emergency medical report, and results of toxicological screening. Claim forms are provided with the policy or may be obtained by contacting your producer or USA Medical Services at the address shown herein or through our website, xxx.xxxxxxxxx.xxx. Bills received in currencies other than U.S. dollars (US$) will be processed in accordance with the exchange rate determined on the date of service at the insurer’s discretion. Addi- tionally, the insurer reserves the right to issue the payment or reimbursement in the currency in which the service or treatment was invoiced. In order for benefits to be paid under this policy, dependent children, after their nineteenth (19th) birthday, must pro- vide a certificate or affidavit from a college or university as evidence that they were full-time students at the time the policy was issued or renewed, AND a written state- ment signed by the policyholder that the dependent child’s marital status is single.

Proof of Claim. The insured must pro- vide written proof of loss consisting of original itemized bills, medical records, and a claim form properly completed and signed to USA Medical Services at 00000 Xxx Xxxxxx Xxxx, Suite 400, Palmetto Bay, Florida 33157, within one hundred eighty (180) days after the treatment or service date. Failure to do so may result in the claim being denied. A completed claim form per incident is required for all claims submit- xxxsubmitted. For claims related to car accidents, the following additional documentation docu- mentation is required for review: police reports, first insurance proof of coverage, emergency medical report, and results of toxicological screening. Claim forms are provided with the policy or may be obtained by contacting your producer or USA Medical Services at the address shown herein or through our website, xxx.xxxxxxxxx.xxx. Bills received in currencies other than U.S. dollars (US$) will be processed in accordance with the exchange rate determined on the date of service at the insurer’s discretion. Addi- tionally, the insurer reserves the right to issue the payment or reimbursement in the currency in which the service or treatment treat- ment was invoiced. In order for benefits to be paid under this policy, dependent children, after their nineteenth (19th) birthdaybirth- day, must pro- vide provide a certificate or affidavit from a college or university as evidence that they were full-time students at the time the policy was issued or renewed, AND a written state- ment statement signed by the policyholder that the dependent child’s marital status is single.