Examples of Claim Information in a sentence
Note: Make copies of the attached Malpractice Claim Information Worksheet and complete for each case.
Once you have provided the Perfected Claim Information we consider your Claim submission to be a “Perfected Claim”.
Five (5) years of currently valued Professional Liability Insurance and General Liability Insurance claim runs from current and prior insurers or complete a Supplemental Claim Information form (SM6236) for each claim.
The date on which you have provided all Perfected Claim Information is considered the “Perfected Claim Date”.
Important Claim Information Complete the form below and keep for ready reference.
You satisfy the requirements of the Claim Information section of the policy.
YES NO If YES, please complete a Supplemental Claim Information form for each.
I have reviewed the information in this Application, gathered information from all partners/directors/ officers/ employees/agents under this entity whether present or prior regarding their knowledge or awareness of any claims or situations which may give rise to any claims The Claim Information Forms, if any, that are attached to this Application include the details of: A.
This information is populated in Loop 2300 Claim Information REF Payer Claim Control Number of the 005010X222A1, 005010X223A2, and 005010X224A2 electronic billing transactions.
The Claim Information Forms, if any, that are attached to this Application include the details of:A.