Common use of Validation of Claims Clause in Contracts

Validation of Claims. ‌ 9.03.01 A member shall complete and submit any form, and perform any reasonable obligation required of them by the City or the Adjudicator of a Plan, to substantiate and/or justify any claim for benefits. In the event that a member refuses to perform obligations required of they have, any benefits and rights provided by these Plans shall be suspended for the period that the member so refuses. 9.03.02 An employee/member who is in receipt of benefits from the Income Protection Plan, Income Replacement Plan, Long Term Disability Plan or benefits under the Workers' Compensation Plan shall ensure that they are available at all times during receipt of benefits to perform any reasonable obligations required by the City or a Plan Adjudicator to substantiate and/or justify any claim for benefits. An employee/member who leaves the Edmonton area while in receipt of Income Protection Plan benefits, Long Term Disability benefits, or Workers' Compensation benefits without obtaining prior approval from the City or the appropriate Plan Adjudicator shall not be entitled to receive such benefits for the whole of the period for which the employee is outside of the Edmonton area. 9.03.03 A claim for benefits arising from an illness or injury which occurred outside of the Province of Alberta must be supported by the submission of a medical certificate describing the illness or injury and signed by a licensed physician. Such claims are also subject to validation by one or more of the following processes as may be required by the City: 9.03.03.01 the submission of receipts for drugs prescribed during the illness or injury (such drugs to be subject to verification as appropriate); 9.03.03.02 the submission of evidence that the physician from whom treatment was received and/or by whom the medical certificate was signed is a medical practitioner in good standing with the medical authorities in the province, state or country; 9.03.03.03 completion of a medical assessment by a medical authority appointed by the City or Plan Adjudicator; 9.03.03.04 such other reasonable processes as may be necessary to validate the claims. 9.03.04 An employee who has been absent from work due to a personal disability may be required to produce a medical certificate signed by a licensed physician which states that such employee is medically fit to return to the duties of their position, in order to be eligible to return to work. 9.03.05 An employee/member shall be responsible for ensuring the accuracy and validity of all claims.

Appears in 2 contracts

Samples: Collective Agreement, Collective Agreement

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Validation of Claims. 9.03.01 A member shall complete and submit any form, and perform any reasonable obligation required of them him/her by the employer City or the Adjudicator of a Plan, to substantiate and/or justify any claim for benefits. In the event that a member refuses to perform obligations required of they havehim/her, any benefits and rights provided by these Plans shall be suspended for the period that the member so refuses. 9.03.02 An employee/member who is in receipt of sick benefits from the Income Protection Plan, Income Replacement Plan, Long Term Disability Plan or sick benefits under the Workers' Compensation Plan shall ensure that they are he/she is available at all times during receipt of benefits to perform any reasonable obligations required by the employer City or a Plan Adjudicator to substantiate and/or justify any claim for benefits. An employee/member who leaves the Edmonton area while in receipt of Income Protection Plan benefits, Long Term Disability benefits, or Workers' Compensation benefits without obtaining prior approval from the employer City or the appropriate Plan Adjudicator shall not be entitled to receive such benefits for the whole of the period for which the employee is outside of the Edmonton area. 9.03.03 A claim for benefits arising from an illness or injury which occurred outside of the Province of Alberta must be supported by the submission of a medical certificate describing the illness or injury and signed by a licensed physician. Such claims are also subject to validation by one or more of the following processes as may be required by the employer City: 9.03.03.01 the submission of receipts for drugs prescribed during the illness or injury (such drugs to be subject to verification as appropriate); 9.03.03.02 the submission of evidence that the physician from whom treatment was received and/or by whom the medical certificate was signed is a medical practitioner in good standing with the medical authorities in the province, state or country; 9.03.03.03 completion of a medical assessment by a medical authority appointed by the employer City or Plan Adjudicator; 9.03.03.04 such other reasonable processes as may be necessary to validate the claims. 9.03.04 An employee who has been absent from work due to a personal disability may be required to produce a medical certificate signed by a licensed physician which states that such employee is medically fit to return to the duties of their position, in order to be eligible to return to work. 9.03.05 An employee/member shall be responsible for ensuring the accuracy and validity of all claims. 9.03.06 An employee/member shall be responsible for any cancellation fees for failure to attend upon a physician should the employee/member agree to the appointment and then fail to attend without the required notice as prescribed by the Physician and/or a medical justification for failing to attend.

Appears in 1 contract

Samples: Collective Agreement

Validation of Claims. ‌ 9.03.01 10.03.01 A member shall complete and submit any form, and perform any reasonable obligation required of them by the City or the Adjudicator of a Planplan, to substantiate and/or justify any claim for benefits. In the event that a member refuses to perform obligations required of they havethem, any benefits and rights provided by these Plans plans shall be suspended for the period that the member so refuses. 9.03.02 10.03.01.01 When a physician’s note is insufficient in the circumstances and therefore the plan adjudicator for the City’s disability income protection plans requests more substantive medical documentation for the purpose of validating a claim for disability benefits, the plan adjudicator will authorize reimbursement of reasonable expenses incurred by the employee, up to maximum allowable fees as determined by the City. 10.03.02 An employee/member who is in receipt of benefits from the Income Protection Plan, Income Replacement Plan, Long Term Disability Plan or benefits under the Workers' Supplementation of Compensation Plan shall ensure that they are available at all times during receipt of benefits to perform any reasonable obligations required by the City or a Plan Adjudicator to substantiate and/or justify any claim for benefits. An employee/member who leaves the Edmonton area while in receipt of Income Protection Plan benefits, Long Term Disability benefits, or Workers' Compensation benefits supplementation without obtaining prior approval from the City or the appropriate Plan Adjudicator shall not be entitled to receive such benefits for the whole of the period for which the employee is outside of the Edmonton area. 9.03.03 10.03.03 A claim for benefits arising from an illness or injury which occurred outside of the Province of Alberta must be supported by the submission of a medical certificate describing the illness or injury and signed by a licensed physician. Such claims are also subject to validation by one or more of the following processes as may be required by the City: 9.03.03.01 the 10.03.03.01 The submission of receipts for drugs prescribed during the illness or injury (such drugs to be subject to verification as appropriate); 9.03.03.02 10.03.03.02 the submission of evidence that the physician from whom treatment was received and/or by whom the medical certificate was signed is a medical practitioner in good standing with the medical authorities in the province, state or country; 9.03.03.03 completion of a medical assessment by a medical authority appointed by the City or Plan Adjudicator; 9.03.03.04 such other reasonable processes as may be necessary to validate the claims; 10. 9.03.04 An employee who has been absent from work due to a personal disability may be required to produce a medical certificate signed by a licensed physician which states that such employee is medically fit to return to the duties of their position, in order to be eligible to return to work. 9.03.05 An employee/member shall be responsible for ensuring the accuracy and validity of all claims.

Appears in 1 contract

Samples: Collective Agreement

Validation of Claims. 9.03.01 A member shall complete and submit any form, and perform any reasonable obligation required of them him/her by the City or the Adjudicator of a Plan, to substantiate and/or justify any claim for benefits. In the event that a member refuses to perform obligations required of they havehim/her, any benefits and rights provided by these Plans shall be suspended for the period that the member so refuses. 9.03.02 An employee/member who is in receipt of benefits from the Income Protection Plan, Income Replacement Plan, Long Term Disability Plan or benefits under the Workers' Compensation Plan shall ensure that they are he/she is available at all times during receipt of benefits to perform any reasonable obligations required by the City or a Plan Adjudicator to substantiate and/or justify any claim for benefits. An employee/member who leaves the Edmonton area while in receipt of Income Protection Plan benefits, Long Term Disability benefits, or Workers' Compensation benefits without obtaining prior approval from the City or the appropriate Plan Adjudicator shall not be entitled to receive such benefits for the whole of the period for which the employee is outside of the Edmonton area.Plan 9.03.03 A claim for benefits arising from an illness or injury which occurred outside of the Province of Alberta must be supported by the submission of a medical certificate describing the illness or injury and signed by a licensed physician. Such claims are also subject to validation by one or more of the following processes as may be required by the City: 9.03.03.01 the submission of receipts for drugs prescribed during the illness or injury (such drugs to be subject to verification as appropriate); 9.03.03.02 the submission of evidence that the physician from whom treatment was received and/or by whom the medical certificate was signed is a medical practitioner in good standing with the medical authorities in the province, state or country; 9.03.03.03 completion of a medical assessment by a medical authority appointed by the City or Plan Adjudicator; 9.03.03.04 such other reasonable processes as may be necessary to validate the claims. 9.03.04 An employee who has been absent from work due to a personal disability may be required to produce a medical certificate signed by a licensed physician which states that such employee is medically fit to return to the duties of their his/her position, in order to be eligible to return to work. 9.03.05 An employee/member shall be responsible for ensuring the accuracy and validity of all claims. 9.03.06 An employee/member shall be responsible for any cancellation fees for failure to attend upon a physician should the employee/member agree to the appointment and then fail to attend without the required notice as prescribed by the Physician and/or a medical justification for failing to attend.

Appears in 1 contract

Samples: Collective Agreement

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Validation of Claims. 9.03.01 A member shall complete and submit any form, and perform any reasonable obligation required of them by the City or the Adjudicator of a Plan, to substantiate and/or justify any claim for benefits. In the event that a member refuses to perform obligations required of they have, any benefits and rights provided by these Plans shall be suspended for the period that the member so refuses. 9.03.02 An employee/member who is in receipt of benefits from the Income Protection Plan, Income Replacement Plan, Long Term Disability Plan or benefits under the Workers' Compensation Plan shall ensure that they are available at all times during receipt of benefits to perform any reasonable obligations required by the City or a Plan Adjudicator to substantiate and/or justify any claim for benefits. An employee/member who leaves the Edmonton area while in receipt of Income Protection Plan benefits, Long Term Disability benefits, or Workers' Compensation benefits without obtaining prior approval from the City or the appropriate Plan Adjudicator shall not be entitled to receive such benefits for the whole of the period for which the employee is outside of the Edmonton area. 9.03.03 A claim for benefits arising from an illness or injury which occurred outside of the Province of Alberta must be supported by the submission of a medical certificate describing the illness or injury and signed by a licensed physician. Such claims are also subject to validation by one or more of the following processes as may be required by the City: 9.03.03.01 the submission of receipts for drugs prescribed during the illness or injury (such drugs to be subject to verification as appropriate); 9.03.03.02 the submission of evidence that the physician from whom treatment was received and/or by whom the medical certificate was signed is a medical practitioner in good standing with the medical authorities in the province, state or country; 9.03.03.03 completion of a medical assessment by a medical authority appointed by the City or Plan Adjudicator; 9.03.03.04 such other reasonable processes as may be necessary to validate the claims. 9.03.04 An employee who has been absent from work due to a personal disability may be required to produce a medical certificate signed by a licensed physician which states that such employee is medically fit to return to the duties of their position, in order to be eligible to return to work. 9.03.05 An employee/member shall be responsible for ensuring the accuracy and validity of all claims.

Appears in 1 contract

Samples: Collective Agreement

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