Common use of GENERAL CLAIMS PROCESSING GUIDELINES Clause in Contracts

GENERAL CLAIMS PROCESSING GUIDELINES. 3.1. The Claims Administrator shall process all claims in a cost-effective and timely manner. 3.2. If the Claims Administrator has a reasonable basis to believe a claim is fraudulent, he or she shall bring the claim to the British Columbia Court for resolution. 3.3. The Claims Administrator has the obligation to institute procedures to assure an acceptable level of reliability and quality control of claims and claims payments. The Claims Administrator has the authority to verify independently all information contained in the materials submitted to the Claims Administrator by or on behalf of a Settlement Class Member and may require (as a condition to payment of a claim) the examination of a Settlement Class Member by a Licensed Medical Practitioner selected by the Claims Administrator. The expense of any such examination or review conducted at the request of the Claims Administrator shall be paid by the Claims Facility. 3.4. To deter potential fraud, all Claim Forms and Ongoing Claim Forms must be submitted and signed under penalties of perjury. The Claims Administrator shall institute proceedings for appropriate review and relief in the event of suspected fraud. When the Claims Administrator suspects fraud, he or she has the authority to require (as a condition to payment of a claim) the examination of the Settlement Class Member, additional laboratory testing of the Settlement Class Member by a laboratory selected by the Claims Administrator and independent tests on explanted and/or ruptured Breast Implant(s). The expenses of any such examination or test conducted at the request of the Claims Administrator shall be paid by the Claims Facility. If any such test or examination supports a finding of fraud, the Claims Administrator shall deny the claim and shall in its sole discretion, seek guidance from the British Columbia Court. 3.5. Unless the Claims Administrator informs and instructs the Settlement Class Member otherwise, the Claims Administrator shall assess each Settlement Class Member’s claim solely on the basis of the materials submitted to the Claims Administrator by and on behalf of the Settlement Class Member. If the Claims Administrator determines that all of the Settlement Class Member’s forms and documentation are acceptable, timely and proper, the Claims Administrator shall approve the Settlement Class Member’s claim. 3.6. The Claims Administrator shall not authorize the release of payment to any Settlement Class Member whose claim has been approved unless and until it has received from the Settlement Class Member all properly executed releases and waivers pursuant to Section 6 of the Agreement. 3.7. The Claims Administrator may delegate, subject to his or her supervision, the implementation of these procedures to the Claims Officers. 3.8. With the exception of the provisions in Paragraph 1.8, above, for the payment of Approved Current Claims and Approved Ongoing Claims by installment, and the provisions in Subparagraph 1.5(v), above, and Paragraph 5.2, below, and Subparagraph 7.1(iii) of the Agreement, the payment of the amount of an Approved Claim to an Approved Claimant is an exclusive, sole and total payment, and under no circumstances will the Approved Claimant receive any further or increased compensation from Dow Corning under this Agreement.