Common use of Claims Handling Services Clause in Contracts

Claims Handling Services. The Administrative Services shall include, as necessary and appropriate, all functions relating to the handling of A&P Claims, including those functions set forth in this Section 5.1. (a) Administrator shall acknowledge, consider, review, investigate, deny, settle, pay or otherwise dispose of each A&P Claim. Administrator shall pay, using its own funds, A&P Claims and associated expenses as Ultimate Net Loss under the LPT Reinsurance Agreement and subject to the terms of the LPT Reinsurance Agreement. (b) Without limiting paragraph (a) of this Section 5.1, Administrator shall: (i) establish, maintain and organize A&P Claim files and maintain and organize other A&P Claims-related records; (ii) review all A&P Claims and determine whether the claimant is eligible for payment and if so, the nature and extent of such payment; (iii) maintain trained claims personnel; (iv) maintain a complaint log with respect to the Reinsured Contracts in accordance with applicable requirements of Governmental Authorities and provide a copy of such log upon Reinsureds’ request; (v) gather all information necessary for Reinsureds to comply with regulatory reporting requirements related to A&P Claims detail, including Medicare Set Aside reporting; (vi) respond promptly to all written or oral A&P Claims-related communications that Administrator reasonably believes to require a response; and (vii) in accordance with Articles VII and XI hereof, respond to, or assist Reinsureds’ in responding to, regulatory and legal matters to the extent such matters relate to A&P Claims.