Common use of Claim Handling Clause in Contracts

Claim Handling. (i) 95% of all claims registration forms and continuing claims forms received will be assessed and the proper response issued by GEFA within 5 Business Days of receipt. 100% of all claims registration forms and continuing claims forms received will be assessed and the proper response issued by GEFA within 10 Business Days of receipt. (ii) The average elapsed time for assessing and responding to claims registration forms and continuing claims forms will be not more than 3 Business Days from receipt. (iii) At the end of a Processing Month, no more than 5% of claims which have not been assessed shall be claims which were received by GEFA more than 10 Business Days prior to the end of that Processing Month. (iv) GEFA will respond to 100% of all incoming claims correspondence within 5 Business Days of receipt. (v) Claims assessment shall result in one of the following: (a) decision to decline; (b) decision to accept/pay; or (c) decision to request further information from a customer/third party, and, where appropriate, GEFA shall generate any documentation associated with the assessment. (vi) Decline process: A system generated letter is issued explaining the decision as part of the assessment process. (vii) Decision to accept/pay process: (a) A letter will be sent to the customer confirming the acceptance of the claim and the payment to be made, clarifying any continuing duty on the customer (e.g. monthly provision of evidence) and including a continuing claim form. (b) A payment run will be executed at least weekly, unless otherwise stated in an Existing Local Agreement. (viii) Further information required: (a) Where further information is required from a third party it will be notified to that third party by mail with a pre-paid business reply envelope. A letter informing the customer of this action will be issued at the same time. (b) Where further information is required from a customer he/she will be notified by mail with a pre-paid business reply envelope. (c) 21-day follow up will occur if there is no response received back from the third party.