Claims Reports Sample Clauses
The Claims Reports clause requires one party, typically the insured, to provide regular or prompt reports detailing any claims or potential claims under an insurance policy. These reports usually include information such as the nature, date, and circumstances of each claim, and may need to be submitted within a specified timeframe after an incident occurs. By mandating timely and accurate reporting, this clause ensures that the insurer is kept informed of potential liabilities, enabling efficient claims management and helping to prevent disputes over late or incomplete notifications.
Claims Reports. The Insurer shall provide a report (a Claims Report) to any Firm to which it has issued a Policy, either in the current or in any previous Indemnity Period, within five working days from receiving a request to do so, setting out (as applicable), as at the date specified in the Claims Report:
Claims Reports. The Manager will establish claim files for each reported claim which will be subject to review by the Company or its representatives at any reasonable time without prior notice. Reports for the Company will be furnished, in formats and frequencies approved by the Company, to show claims fund activity and payments, losses paid, pending and reserved, by participant coverage, type, cause function, size, and so on. The Manager will assist as needed with all litigation and defense activities related to claims pursuant to the Company program within guidelines established by the Company. These activities shall include recommendation of attorneys on a case or retainer basis for approval by the Company, preparation of all claim documentation, retention of witnesses and performance of other steps as necessary to properly defend against claims against insureds of the Company.
Claims Reports. HMO must comply with Claims Reports submission requirements specified in HHSC’s Texas Medicaid Managed Care Claims Manual. The reports must be submitted to HHSC in a format specified within the Texas Medicaid Managed Care Claims Manual and/or report templates provided by HHSC.
Claims Reports. The Insurer shall provide a report (a “Claims Report”) to any Firm to which it has issued a Policy either in the then current or in any previous Indemnity Period, within a reasonable time from receiving a request to do so, setting out (as applicable), as at the date specified in the Claims Report:—
7.6.1 a summary of each Claim of which the Insurer is aware made against the Firm under each Policy;
7.6.2 the amount reserved by the Insurer against each Claim;
7.6.3 the basis on which each such amount is calculated (for example, whether the figure represents a loss actually incurred, an estimate of probable maximum loss, or any other basis of reserving);
7.6.4 whether or not each such amount includes Defence Costs;
7.6.5 whether each such amount includes or is in excess of the amount of any excess or deductible that may apply in relation to such Claim, and the amount of any such excess or deductible; and
7.6.6 any amounts paid out in relation to each Claim, in each case indicating whether such sums include any excess or deductible due from but not paid by the Firm.
Claims Reports. 6.5 The Insurer shall provide a report (a Claims Report) to any Firm to which it has issued a Policy, either in the current or in any previous Indemnity Period, within five working days from receiving a request to do so, setting out (as applicable), as at the date specified in the Claims Report:
6.5.1 a summary of each claim (or series of related claims) of which the Insurer is aware made against the Firm under each Policy;
6.5.2 the amount reserved by the Insurer against each claim (or series of related claims);
6.5.3 the basis on which each such amount is calculated (for example, whether the figure represents a loss actually incurred, an estimate of probable maximum loss, or any other basis of reserving);
6.5.4 whether or not each such amount includes defence costs;
6.5.5 whether each such amount includes or is in excess of the amount of any deductible that may apply in relation to such claim (or series of related claims), and the amount of any such deductible; and
6.5.6 any amounts paid out in relation to each claim, in each case indicating whether such sums include any deductible due from but not paid by the Firm.
Claims Reports. 8.1 Claims reports shall be supplied to the Contracting Body, Broker and Insurer (where the Claims Handler is not the Insurer): no later than 90 days prior to expiry of the current period or within 30 days of any request by the Contracting Body or other frequency agreed in the Market Presentation.
8.2 The content of the claims reports will be agreed between the Contracting Body, Insurer, Broker (if applicable) and the Claims Handler (where not the Insurer). The report will include the following as a minimum unless otherwise agreed with the Contracting Body:
8.2.1 Report date;
8.2.2 Policy reference;
8.2.3 Contracting Body claims reference;
8.2.4 Claims Handler claims reference;
8.2.5 Insurer claim reference;
8.2.6 Date of incident;
8.2.7 Location of incident / postcode;
8.2.8 Claimant forename (Motor and Liability classes only);
8.2.9 Claimant surname (Motor and Liability classes only);
8.2.10 Incident details;
8.2.11 Source Code;
8.2.12 Excess;
8.2.13 Amount of damage paid before deduction of Excess (GBP);
8.2.14 Amount of damage outstanding before deduction of Excess;
8.2.15 Injury paid before deduction of Excess (GBP) (motor and liability classes only);
8.2.16 Injury outstanding before deduction of Excess (GBP) (Motor and Liability classes only);
8.2.17 Total payments made (GBP);
8.2.18 Recoveries received (GBP);
8.2.19 Balance left in fund (if using funded methodology) (GBP);
8.2.20 Nature of the incident;
8.2.21 Damage recovery (GBP) (motor only);
8.2.22 Net damage paid (GBP) (motor only);
8.2.23 Interest earned (GBP) (if using funded methodology); and
8.2.24 Fund transactions (GBP) (if using funded methodology).
8.3 The claims reports are to be made available in Excel or CSV format.
8.4 The timeliness of the claims reports shall be confirmed by the Contracting Body in the Market Presentation.
8.5 The Contracting Body may require the Insurer to conduct a claims and trend analysis based on the claims history / report. This will be confirmed by the Contracting Body in the Market Presentation.
8.6 The Contracting Body may require an on line solution. This will be confirmed in the Market Presentation.
8.7 The Contracting Body or Broker (where applicable) and the Insurer will agree the claims reports within 30 days of receipt of the claims report from the Claims Handler.
Claims Reports. The Insurer shall provide a report (a “Claims Report”) to any Firm to which it has issued a Policy either in the then current or in any previous Indemnity Period, within a reasonable time from receiving a request to do so, setting out (as applicable), as at the date specified in the Claims Report:—
7.6.1 a summary of each Claim of which the Insurer is aware made against the Firm under each Policy; and
7.6.2 the amount reserved by the Insurer against each Claim; and
7.6.3 the basis on which each such amount is calculated (for example, whether the figure represents a loss actually incurred, an estimate of probable maximum loss, or any other basis of reserving); and
7.6.4 whether or not each such amount includes Defence Costs; and
7.6.5 whether each such amount includes or is in excess of the amount of any Self-Insured Excess that may apply in relation to such Claim, and the amount of any such Self- Insured Excess; and
Claims Reports a. Prepare encounter data reports
b. Prepare accounts receivable reports
c. Prepare accounts payable reports (if applicable)
d. Prepare month-end claims financial report as appropriate (i.e. lags and IBNR
e. Provide claims utilization/encounter data reports to meet Payer requirements
Claims Reports. Contract Administrator will provide to the Plan Sponsor, at the Plan Sponsor's reasonable written request, Contract Administrator's standard reports and data extracts as further described in Exhibit C, Section 15 as permitted under HIPAA. Unless otherwise requested by the Plan Sponsor, the Contract Administrator may adjust all such information provided to the Plan Sponsor to prevent the disclosure of the identity of any Plan Participant. Additional reports and data extracts requested will be billed at an hourly rate.
Claims Reports. These reports assist OMPP in monitoring the Contractor’s claims processing activities to ensure appropriate member access to services and payments to providers. The Contractor shall submit claims processing and adjudication data. The Contractor shall also identify specific cases and trends to prevent and respond to any potential problems relating to timely and appropriate claims processing. Examples of Claims Reports to be submitted by the Contractor, in accordance with the terms of the MCE Reporting Manuals, include but are not limited to: Adjudicated Claims Summary, including Claims Aging Summary and Claims Lag Report; Top 10 Claims Denial Reasons; and Claims Processing Summary, including Outstanding Claims Inventory Summary and Interest Paid on Claims.