Reso 2001-399 - Laserfiche WebLink

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CLAIMS PROCEDURES NOTICE OF CLAIM, Written notice of claim: 1. may be given at any time during the Elimination Period; and 2. must be given by the 20th day after a covered period of Disability ends. The notice must be sent to the Company's Home OffIce, It should include: 1. the Insured Employee's name and address; and 2. the number of this Policy, If this is not possible, written notice must be given as soon as it is reasonably possible, CLAIM FORMS. When notice of claim is received, the Company will send claim forms to the Insured Employee. If the Company does not send the forms within 15 days; then the Insured Employee may send the Company written proof of Disability in a letter stating the date the Disability started, its cause and degree. The Company will periodically send the Insured Employee additional Claim Forms. PROOF OF CLAIM. The Company must be given written proof of claim within 90 days after the end of each period for which the Company is liable, If it was not reasonably possible to give written proof in the time required, the claim will not be reduced or denied solely for this reason; provided the proof is fIled as soon as reasonably possible, In any event, proof of claim must be given no later than one year from such time, These time limits will not apply while an Insured Employee lacks legal capacity, however, Proof of claim must be provided at the Insured Employee's own expense, It must show the date the Disability started, its cause and degree, It must show any restrictions on performing the duties of the Insured Employee's regular occupation. Documentation must include: 1, completed statements by the Insured Employee, the Employer and the attending Physician; 2. a signed authorization for the Company to obtain more information; and 3. any other items the Company may reasonably require in support of the claim, Proof of continued Disability and regular attendance of a Physician must be given to the Company, within 60 days after the Company requests it; if it is not, benefIts may be denied or suspended. EXAM OR AUTOPSY. At anytime while a claim is pending, the Company may: 1. have the Insured Employee examined by a Physician, specialist or vocational rehabilitation expert of the Company's choice, as often as reasonably required; and deny or suspend benefIts for an Insured Employee who fails to attend an exam, without good cause; or who fails to cooperate with the examiner. The Company may also have an autopsy done, where it is not forbidden by law. Any such exam or autopsy will be at the Company's expense. TIME OF PAYMENT OF CLAIMS. When the Company receives proof of claim, benefIts payable under this Policy will be paid as follows. 1. 2. Any Long Term Disability benefIts will be paid monthly, during any period for which the Company is liable. If benefIts are due for less than a month, they will be paid on a prorata basis. The daily rate will equal 1/30 of the monthly benefIt. Any balance which remains unpaid at the end of the period of liability will be paid immediately upon receipt of due written proof. TO WHOM PAYABLE. All benefIts are payable to the Insured Employee; except after his or her death benefIts will be payable as follows. 1. Any Survivor BenefIt will be payable in accord with that Policy provision. 2, Any other benefIts will be payable to the Insured Employee's estate. When a benefIt becomes payable to the Insured Employee's estate, a minor or any other person who is not legally competent to give a valid receipt; then up to $3,000 may be paid to any relative of the Insured Employee that the Company fmds entitled to payment. If payment is made in good faith to such a relative, the Company will not have to pay that benefIt again. NOTICE OF CLAIM DECISION, Within a reasonable time after receiving proof of loss, the Company will send the Insured Employee a written notice of their claim decision, If the Company denies any part of the claim, the written notice will: 1, explain the reason for tIie denial under the terms of this Policy; and 2. inform the Insured Employee of the right to a review of the Company's decision, If the Insured Employee does not receive a written decision within 90 days after the Company receives his or her claim; then the Insured Employee has a right to an immediate review, as if the claim was denied, 2. GL3001-LTD-8 98 FL 11 01/01101