Common use of Claims Practices Clause in Contracts

Claims Practices. It is the Company’s sole decision to determine whether to investigate, contest, compromise or litigate a claim; however, the Company is responsible for investigating, contesting, compromising or litigating Reinsured Policy claims in accordance with applicable law and policy terms. The Company acknowledges that it obtains certified death certificates for death claims unless otherwise agreed to by the reinsurer, and follows industry standard and investigates claims with any of the following criteria: a) If there is a reasonable question regarding the validity of the insured’s death or the authenticity of the proofs of death; or b) If the death occurs outside the United States or Canada; or c) If the insured is missing or presumed dead; or d) If there is a reasonable suspicion of fraud. A claim investigation generally includes confirming proof of death and financial condition, if material, at the time of Policy application. Investigations may also include obtaining police reports, coroner’s reports, financial records, or other information that would be appropriate under the circumstances. The Company acknowledges that it does defend against claims meeting the following criteria: e) If fraud is found and there is a legal remedy available; or f) If there is insufficient proof of death.