Liability for Claims Decisions Clause Samples
The "Liability for Claims Decisions" clause defines which party is responsible for the outcomes and consequences of decisions made regarding insurance or benefit claims. Typically, this clause clarifies whether the insurer, administrator, or another party bears legal and financial responsibility if a claim is denied, delayed, or mishandled. For example, it may specify that the insurer is solely liable for any errors in claim adjudication, or that a third-party administrator assumes certain liabilities. The core function of this clause is to allocate risk and responsibility, ensuring that all parties understand who will be accountable for claims-related disputes or liabilities.
Liability for Claims Decisions. Payors shall be liable for claims decisions and for the payment of Payors' portions of claims pursuant to the applicable Plan. Beech is not a Payor and shall not be responsible or liable for any claims decisions or for the payment of any claims submitted by Provider for furnishing Covered Services or non-Covered Services to Eligible Persons. Beech shall not be an insurer, guarantor or underwriter of the responsibility or liability of any Payor or any other party to benefits pursuant to any Plan.