The Claims Process Clause Samples

The Claims Process. 5.1. You agree to provide to Us throughout the term of the Agreement all appropriate and available information relating to your potential claim/Claim as soon as possible. The information that You provideshouldbetrueandaccuratetothebestofyourknowledgeandbelief.PleasenotethatifYou fail to provide Us with this information as described in this paragraph, you may impede our delivery of the Services to Youand Youmay become liable to Us for costs under paragraphs 7.1. and 7.2. 5.2. Once We have received your signed Letter of Authority Form or,if later, sufficient information from You, We will assess whether We consider your potential claim to be viable. 5.3. If We are providing a Preliminary Claims Service to You and We consider that your Claim is viable, We will provide the relevant information that We have received from Youto,and introduce You to,a service provider who can progress your Claim Please note that in respect of any Preliminary Claims Service, your engagement with the service provider will be a separate contractual relationship between You and them and We will have no obligations to You under that engagement. 5.4. If We are providing You with a Full Claims Service, and We consider that your Claim is viable We will: 5.4.1. raise a formal complaint or claim with theThird Party regarding your Claim; 5.4.2. provide the Third Party with the relevant information that We have received from You; 5.4.3. promptly notify You of any material developments or delays regarding your Claim; 5.4.4. promptly notifyYouonceWe are informedof the outcomeof the Claim. 5.5. If, at our complete discretion, We consider that your potential Claim is not viable (whether due to it being outside any applicable limitation period, the claimed amount being too small or for any other reason), We will notify You, following which You will not be required to pay anything to Us and We will have no further obligations to You under the Agreement and We shall be entitled, without incurring any liability toYou, to cease to provide the Services in relation to the claim.

The Claims Process. How to Submit a Claim

The Claims Process. If the other Plan does not provide for Co-ordination of Benefits, it will be considered as the Primary Carrier, and will be responsible for making the initial payment toward the eligible expense. • If the other Plan does provide for Co-ordination of Benefits, the following rules are applied to determine which Plan is the Primary Carrier. – For Claims incurred by you or your Dependent Spouse: The Plan insuring you or your Dependent Spouse as an employee/member pays benefits before the Plan insuring you or your Spouse as a dependent. In situations where you or your Dependent Spouse have coverage as an employee/member under more than one Plan, the order of benefit payment will be determined as follows: ° The Plan where the person is covered as an active full-time employee, then ° The Plan where the person is covered as an active part-time employee, then ° The Plan where the person is covered as a retiree. – For Claims incurred by your Dependent Child: The Plan covering the parent whose birthday (month/day) is earlier in the calendar year pays benefits first. If both parents have the same birthdate, the Plan covering the parent whose first name begins with the earlier letter in the alphabet pays first. However, if you and your Spouse are separated or divorced, the following order applies: ° The Plan of the parent with custody of the child, then ° The Plan of the spouse of the parent with custody of the child (i.e., if the parent with custody of the child remarries or has a common-law spouse, the new spouse’s Plan will pay benefits for the Dependent Child), then ° The Plan of the parent not having custody of the child, then ° The Plan of the spouse of the parent not having custody of the child (i.e., if the parent without custody of the child remarries or has a common-law spouse, the new spouse’s Plan will pay benefits for the Dependent Child). • Where you and your spouse share joint custody of the child, the Plan covering the parent whose birthday (month/day) is earlier in the calendar year pays benefits first. If both parents have the same birthdate, the Plan covering the parent whose first name begins with the earlier letter in the alphabet pays first. Community Living Huronia 13

The Claims Process. A claim for accidental injury to natural teeth will be determined under Extended Health Care Plans with accidental dental coverage before it is considered under Dental Plans. • If the order of benefit payment cannot be determined from the above, the benefits payable under each Plan will be in proportion to the amount that would have been payable if Co-ordination of Benefits did not exist. • If the insured person is also covered under an individual travel insurance plan, benefits will be co-ordinated in accordance with the guidelines provided by the Canadian Life and Health Insurance Association. Submitting a Claim for Co-ordination of Benefits To submit a claim when Co-ordination of Benefits applies, refer to the following guidelines: • As per the Order of Benefit Payment section, determine which Plan is the Primary Carrier and which is the Secondary Carrier. • Submit all necessary claim forms and original receipts to the Primary Carrier. • Keep a photocopy of each receipt or ask the Primary Carrier to return the original receipts to you once your claim has been settled. • Once your claim has been settled by the Primary Carrier, you will receive a statement outlining how your claim has been handled. Submit this statement along with all necessary claim forms and receipts to the Secondary Carrier for further consideration of payment, if applicable.

The Claims Process. 4.1. You shall provide to Us throughout the term of the Agreement all appropriate and available information relating to Your Claim as soon as possible. We will rely on all of the information that You provide as being true and accurate and You must promptly notify Us in writing should You become aware that any information You have provided is untrue, inaccurate or misleading in any way. 4.2. Once We have received Your signed Letter of Authority Form and issued a Letter of Instruction to You (or, if later, received sufficient information from You), We will assess whether We consider Your Claim to be viable. If We consider that it is viable, We will: 4.2.1 submit that as a Claim to the Bank, requesting (as applicable) full details of the Product(s) and the circumstances surrounding its provision and/or the circumstances or other matters relating to the subject matter of Your Claim and requesting financial redress of such sum as We consider to be reasonable based on the information that You have provided to Us and notify You that we have raised such a Claim on Your behalf; 4.2.2 provide the Bank with any relevant information that We have received from You; 4.2.3 take such action to progress Your Claim as We consider reasonably appropriate and use Our reasonable endeavours to communicate with the Bank for a settlement of Your Claim; 4.2.4 provide to You or obtain for You an assessment as to whether any proposed Settlement Amount is appropriate redress, based on a calculation of appropriate financial redress in respect of Your Claim; and 4.2.5 promptly notify You once We are informed of the outcome of the Claim. 4.2.1 familiarise ourselves with Your previous Claim and offers to settle that previous Claim; 4.2.2 advise You as to whether We consider there is a viable prospect of You obtaining an Improved Offer in respect of that previous Claim; 4.2.3 where We consider that there is a viable prospect of You obtaining an Improved Offer, take such action to progress Your Claim (including the submission of Your Claim to the applicable Bank) as We consider reasonably appropriate and use Our reasonable endeavours to communicate with the Bank for a settlement of Your Claim; 4.2.4 provide to You or obtain for You an assessment as to whether any proposed Improved Offer is appropriate redress, based on a calculation of appropriate financial redress in respect of Your Claim; and 4.2.5 promptly notify You once We are informed of the outcome of the Claim. 4.3. If, at Our compl...

The Claims Process. Where you and your spouse share joint custody of the child, the Plan covering the parent whose birthday is earlier in the calendar year pays benefits first. If both parents have the same birthdate, the Plan covering the parent whose first name begins with the earlier letter in the alphabet pays first. A claim for accidental injury to natural teeth will be determined under Extended Health Care Plans with accidental dental coverage before it is considered under Dental Plans. If the order of benefit payment cannot be determined from the above, the benefits payable under each Plan will be in proportion to the amount that would have been payable if Co-ordination of Benefits did not exist. If the person is also covered under an individual travel insurance plan, benefits will be co-ordinated in accordance with the guidelines provided by the Canadian Life and Health Insurance Association. Submitting a Claim for Co-ordination of Benefits As per the Order of Benefit Payment section, determine which Plan is the Primary Carrier and which is the Secondary Carrier. Submit all necessary claim forms and original receipts to the Primary Carrier. Keep a photocopy of each receipt or ask the Primary Carrier to return the original receipts to you once your claim has been settled. Once your claim has been settled by the Primary Carrier, you will receive a statement outlining how your claim has been handled. Submit this statement along with all necessary claim forms and receipts to the Secondary Carrier for further consideration of payment, if applicable. Note: Your Plan has mandatory Co-ordination of Benefits. Unless you it is assumed that your Plan the Primary Carrier for your claims only. Unless your employer has complete Co-ordination of Benefits information on file with respect to your eligible dependents, your Plan assumes that your spouse has coverage and that his or her Plan is the Primary Carrier.

The Claims Process. The Claim

The Claims Process. Order of Benefit Payment

The Claims Process. As per the Order of Benefit Payment section, determine which Plan is the Primary Carrier and which is the Secondary Carrier. Submit all necessary claim forms and original receipts to the Carrier. Keep a photocopy of each receipt or ask the Primary Carrier to return the original receipts to you once your claim has been settled. Once your claim has been settled by the Primary Carrier, you will receive a statement outlining how your claim has been handled. Submit this statement along with all necessary claim forms and receipts to the Secondary Carrier for further consideration of payment, if applicable.