Claim Processing Clause Examples
The Claim Processing clause outlines the procedures and requirements for submitting, reviewing, and resolving claims under an agreement. Typically, it specifies the steps a party must follow to notify the other party of a claim, the documentation required, and the timelines for response and resolution. For example, it may require written notice of a claim within a certain number of days and set out how supporting evidence should be provided. This clause ensures that claims are handled in an orderly and timely manner, reducing disputes and promoting efficient resolution of issues.
Claim Processing i. The Insured / Insured Person shall after intimation as aforesaid, further submit within 30 days of discharge from Hospital the following:- - Duly filled claim form(s) - Discharge / card from the Hospital / Medical Practitioner indicating the number of days of stay.
ii. The Insured / Insured Person shall at any time as may be required authorize and permit the Company or anyone deputed by them in this behalf to obtain any further information or records from the Hospital, Medical Practitioner, Lab or other agency, in connection with the treatment relating to the claim. Where the documents submitted for claim are required for a claim under any other reimbursement policy, the documents will be returned after the processing of the claim on request of the Insured / Insured Person. Alternatively if the claim is submitted to another insurer / TPA for processing under an indemnity policy, attested copies from the Insurer / TPA may be provided with a copy of such indemnity policy. The above list is only indicative. The Company may call for additional documents / information and / or carry out verification on a case to case basis to ascertain the facts / collect additional information / documents of the case to determine the assessment of loss. Verification carried out if any will be done by Professional Investigators or member of the Service Provider and costs for such investigations shall be borne by the Company.
Claim Processing. The Owner shall pay a claim processing fee of $[**] for each defaulted Student Loan per claim package filed. Claim processing shall include, without limitation, presentation to Insurer of all documentation required under the Servicing Guidelines, in the form required thereunder. Servicer will provide DDB Certification and Closed School Certification at no charge.
Claim Processing. Claims made under this Warranty must be submitted by Buyer within 4 Months from the date of failure to the attention of the Warranty Administrator at any of the addresses listed below and must contain the following information:
a. Claim number
b. Vehicle Identification number (17 characters) or equipment serial number
c. Engine model
d. Transmission model
e. Date of incident
f. Repairing dealer code
g. In-service date
h. Complete model number of AxleTech’s component
i. Description of failure
j. Serial number of AxleTech’s component
k. Vehicle model number
l. AxleTech application approval number
Claim Processing i) The bank will forward (Upload on portal) scan copy of document through e-mail and the company will start processing of claim on the basis of scanned documents.
ii) On Death Claim intimation the following documents to be submitted. The claim will be settled within a TAT (turn around time) of 15 working days in case of all the below requirements are received.
a) Claim Form completely filled, signed by nominee and attested by Master Policy Holder (MPH) with correct Master Policy Number and Member Id. Incomplete forms if received will not be considered. Further processing will be done after receipt of all complete requirements.
b) Death Certificate issued by Birth and Death Registrar under 12/17 format duly attested by MPH.
c) Copy of Self Declaration of good health should be mandatorily attached along with claim documents for all claims where sum assured is above 0.75 Lakh.
d) Proof of Age of Life Assured, preferably AADHAR CARD.
e) Cause of Death Certificate
f) Bank Pass Book (in respective RSCB/DCCB) and KYC of nominee duly attested by MPH, In case if nominee’s bank account details is of different bank (other than RSCB/DCCB), the claim will be credited to the said bank account based on the proof given along with claim form. This has to be attached with the claim forms or else the document will be treated as insufficient. If the above requirements are compiled without any mismatch in any vital detail like nominees name/life assureds Name Etc, in the claim form and in our records then death claim will be settled as per Agreement.
g) All the deficiencies/objections in the claim should be communicated to the concerned bank altogether in a single communication only by the insurance company This Agreement is final binding on both parties and no other clauses will be imposed by the Insurance Company in the name of conditions of their product. If any claim is rejected on the basis of terms and conditions of the approved product of the Insurance Company, which is not mentioned, or not as per the Agreement, it will be treated, as breach of Agreement and the insurance company will be solely responsible for all the damages.
iii) If the claim is not settled by the Insurance Company within the prescribed period, then, the company shall pay interest, as per IRDA guidelines. For gross delay in majority of claims bank may consider imposing penalty and can even blacklist the company. The bank may pay interest amount along with claim amount to the claimant from performance...
Claim Processing. Customer shall be charged a fee in the amount of $.08 for each transmission of a claim or claims which passes through the switching services of RSL if billed by RSL. (A transmission may include more than one claim). All Tariffs, Taxes, Up charges and Fees shall be passed on and paid for by customer. The amount due under the terms of this paragraph is due and payable twenty (20) days after the receipt of the invoice from RSL. If payment is made more than thirty (30) days after receipt of invoice from RSL, Customer agrees to pay a late fee of one percent (1%) on all delinquent invoices. Such late fee shall not accrue if there is a bona fide dispute between the parties as to the amounts due. In the event the amounts provided for under the terms of this paragraph are not received by RSL by the 20th day after Customer’s receipt of an invoice from RSL, then RSL and Customer agree that RSL shall have the right to terminate all services hereunder, including the services relating to the processing of such claims. If services are terminated and Customer requests reconnection, a reconnect fee in the amount of $1,000.00 will be charged. Customer shall be liable for and shall pay to RSL all expenses incurred by RSL in connection with the collection of any sums due hereunder, including all collection expenses, reasonable attorney’s fees and court costs.
Claim Processing. By this Agreement, USA Funds and the Lender agree that upon the filing of a claim by the Lender, such claim will be processed in the following manner:
1. In the event of a Default, the Lender will follow (or cause to be followed) the procedures set forth in the Policies. USA Funds does not guarantee payment by the Borrower of any delinquency charges imposed for late payments and will not accept a Default claim based solely on non-payment of such charges. Upon receipt by USA Funds from the Lender (or servicer) of a Default notice together with an original or certified copy of the Note assigned to USA Funds, and documentation as set forth in the Policies that the Loan evidenced by such Note was originated and serviced, and collection efforts were made, in accordance with applicable laws and regulations and with the Policies, USA Funds will pay to the Lender the maximum percentage of the unpaid balance of principal and interest due on- such Loan allowable under the terms of the Act and the Policies (other than any portion of such interest payable by the U.S. Department of Education under the Act), provided the Lender (or servicer) has complied in all material respects with the requirements of the Loan Program, this Agreement, and the Policies in respect of such Note. USA Funds will thereupon succeed to all the rights of the Lender under such Loan. No claim submitted to USA Funds by the Lender (or loan servicer) with respect to a Loan that has been Guaranteed by USA Funds will be paid by USA Funds unless USA Funds has received from the Lender (or loan servicer) the appropriate documentation; and
2. Upon bankruptcy, death, or permanent and total disability, as defined in the Act, of the Borrower or other circumstances under the Act provides for guarantors to pay claims to lenders (e.g., closed school or false certification), USA Funds will pay to the Lender the maximum percentage of the unpaid balance of principal and interest due on such Loan allowable under the terms of the Act and the Policies (other than any portion of such interest payable by the U.S. Department of Education under the Act), provided the Lender (or loan servicer) has complied in all material respects with the requirements of the Loan Program, this Agreement and the Policies.
Claim Processing. The Successful Service Provider will at a minimum be required to provide the following claim processing services: • The Service Provider will provide the District with electronic access to all claims. • The Service Provider will provide each Library Learning Commons with a monthly claims status report. • The Service Provider will advise the Library Learning Commons of all time limitations required for the acceptance of claims by any individual publication title. • The Service Provider will be responsible for handling all correspondence with the publisher in regard to claims, address changes, cancellations, or other communications, unless advised otherwise (in writing) by the District. • The Service Provider must respond within seventy-two (72) hours to any telephone or email claim/inquiry.
Claim Processing. If a properly-completed application is denied, in whole or in part, a claimant will be notified within 90 days (normally within 45 days) after receipt of the written claim. In some cases additional time may be needed; if so, the claimant will be advised of the special circumstances requiring more time and when an answer may be expected. If it is determined that a claimant is not entitled to benefits under this Plan, or that a claimant is entitled to a lesser benefit than the amount claimed, the claimant will be furnished with a written statement which includes:
1. The specific reason or reasons for the denial or reduction;
Claim Processing. All claims on Consolidation Loans Guaranteed pursuant to this Certificate and all related administrative functions to be performed by USA Funds pursuant to this Certificate, the Agreement, or the Policies shall be processed or performed by USA Funds or its contractor located in Fishers, Indiana or at such other office as may be designated by USA Funds.
Claim Processing. With respect to Keep Policies in which the Insured is deceased or hereafter dies, the Servicer will use reasonable efforts to obtain all necessary information and documentation, including death certificates and claim packages, necessary to submit claims to collect the Keep Policies benefits in accordance with the following procedure:
(a) upon actual knowledge or notification of death, the Servicer will obtain a certified copy of the Insured’s death certificate or other appropriate evidence of death from the appropriate agency;
(b) the Servicer will obtain from the respective insurer any and all forms or other documentation necessary to submit the claim; (c) the Servicer will calculate the death benefit distribution amounts and payees, (d) the Servicer will apply for all applicable death benefits under the Keep Policies applicable to such Insured; (e) the Servicer will perform follow-up correspondence with insurance carriers in connection with such claims (f) the Servicer will distribute benefits to holders of beneficial interests in applicable policies; (g) the Servicer will perform additional correspondence with such holders including tax reporting; and (h) the Servicer will perform accounting and tax services in connection with such claims.