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Jefferson Pilot Life Ins.#1
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RFP No. 01-10-01 Employee Dental, Life, Insurance
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Jefferson Pilot Life Ins.#1
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Last modified
6/18/2012 10:02:26 PM
Creation date
12/28/2010 3:46:06 PM
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CityClerk-Bids_RFP_RFQ
Project Name
Employee Insurance
Bid No. (xx-xx-xx)
01-10-01
Project Type (Bid, RFP, RFQ)
RFP
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, <br />CLAIMS PROCEDURES <br />FOR LIFE OR ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS <br />4OTE: If this Policy includes an Extension of Death Benefit or a Living Benefit (also called an Accelerated Death <br />enefit), please refer to that section for special claim procedures. <br />NOTICE OF CLAIM. Written notice of claim must be given within 20 days after the loss occurs. The notice must be sent <br />to the Company's Home Office. It should include: <br />(1) the Insured Person's name and address; and <br />(2) the number of this Policy. <br />If this is not possible, written notice must be given as soon as it is reasonably possible. <br />CLAIM FORMS. When notice of claim is received, the Company will send claim forms for filing the required proof. If the <br />Company does not send the forms within 15 days; then the Insured Person or Beneficiary may send the Company written <br />proof of claim in a letter stating the nature, date and cause of the loss. <br />PROOF OF CLAIM. The Company must be given written proof of claim within 90 days after the date of the loss. If it was <br />not reasonably possible to give written proof in the time required, the claim will not be reduced or denied solely for this <br />reason; provided the proof is filed as soon as reasonably possible. In any event, proof of claim must be given no later <br />than one year from such time. These time limits will not apply while the Insured Person or Beneficiary lacks legal <br />capacity, however. <br />Proof of claim must be provided at the Insured Person's or Beneficiary's own expense. It must show the nature, date and <br />cause of the loss. Documentation must include: <br />(1) a certified copy of the death certificate, for proof of death; <br />(2) a copy of any police report, for proof of accidental death or dismemberment; <br />(3) a signed authorization for the Company to obtain more information; and <br />(4) any other items the Company may reasonably require in support of the claim. <br />EXAM OR AUTOPSY. At anytime while a claim is pending, the Company may: <br />(1) have the Insured Person examined by a Physician of the Company's choice, as often as reasonably <br />0 required; and <br />(2) deny or suspend benefits if the Insured Person fails to attend an exam, without good cause; or fails to <br />cooperate with the examiner. <br />In case of death, the Company may also have an autopsy done, where it is not forbidden by law. Any such exam or <br />autopsy will be at the Company's expense. <br />TIME OF PAYMENT OF CLAIMS. Death or dismemberment benefits payable under this Policy will be paid as soon as <br />the Company receives acceptable proof of claim. <br />In any event, the Company shall pay or deny any claim within 120 days after receiving it. If payment is not sent by the <br />120th day, any overdue payment of accidental death or dismemberment benefits will accrue simple interest at the rate of <br />10% per year. <br />TO WHOM PAYABLE. Any benefits payable for the Insured Person's death will be paid in accord with the Beneficiary, <br />Facility of Payment and Settlement Options sections of this Policy. If this Policy includes Dependent Life Insurance, any <br />benefits payable for an insured Dependent's death will be paid to: <br />(1) the Insured Person, if he or she survives that Dependent; or <br />(2) the Insured Person's Beneficiary, or in accord with the Facility of Payment section; if the Insured Person <br />does not survive that Dependent. <br />If this Policy includes Accidental Death and Dismemberment Benefits; then any benefit, other than the Insured Person's <br />death benefit, will be paid to the Insured Person. <br />NOTICE OF CLAIM DECISION. Within a reasonable time after receiving proof of claim, the Company will send the <br />Insured Person or Beneficiary a written notice of their claim decision. If the Company denies any part of the claim, the <br />written notice will: <br />(1) explain the reason for the denial under the terms of this Policy; and <br />(2) inform the Insured Person or Beneficiary of the right to a review of the Company's decision. <br />fithe Insured Person or Beneficiary does not receive a written decision within 90 days after the Company receives the <br />laim; then there is a right to an immediate review, as if the claim was denied. <br />GL1101 -13A FL L /ADD <br />18 05101101 <br />
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