Submission of Claim Forms Clause Samples
The 'Submission of Claim Forms' clause outlines the requirement for parties to formally notify the other party of a claim by submitting a designated claim form. Typically, this clause specifies the format, content, and timeframe within which the claim form must be completed and delivered, such as providing supporting documentation or using a prescribed template. Its core practical function is to ensure that claims are communicated in a clear, standardized manner, thereby reducing misunderstandings and facilitating efficient processing and resolution of claims.
Submission of Claim Forms. 5.1 For a Settlement Class Member to be paid from the Net Settlement Fund, he or she must complete and timely submit a Claim Form certifying the Settlement Class Member’s entitlement to a claim as described. The Claim Form shall be deemed deficient by the Claims Administrator if it is not fully completed and signed, and, accordingly, will be rejected upon receipt subject to the ability to cure the deficiency as described in Section 5.6 below.
5.2 The Claims Administrator will develop and post an online version of the Claim Form that may be “certified” and submitted electronically.
5.3 Individuals may contact the Claims Administrator prior to submitting a Claim Form to inquire how many qualifying calls are shown by the Potential Class Member Contact List. Individuals may dispute the number of telephone calls associated with their telephone number or numbers by contacting the Claims Administrator to submit a dispute. Detailed instructions on how to submit a dispute regarding the number of qualifying calls will be provided in the Long-Form Settlement Notice (Exhibit B) and in the FAQs on the Settlement Website. Individuals may be required by the Claims Administrator to provide proof of their telephone calls to Defendants during the Class Period. All disputes must be submitted by the deadline to submit a claim; provided however, that if an individual requests an extension of time to submit a dispute, the Claims Administrator shall review that request with Class Counsel and Defense Counsel and decide if the request for additional time shall be granted and shall promptly communicate that decision to the individual making the request. The Claims Administrator shall make a final and binding resolution of any disputes submitted pursuant to this Section 5.
5.4 Individuals submitting Claim Forms will be required to provide a unique code. The code will be provided on the Summary Settlement Class Notice (Exhibit C). Individuals may also obtain the required code by contacting the Claims Administrator by telephone or email, as described in the notices and as posted on the Settlement Website and providing a telephone number on the Potential Class Member Contact List or other proof that they are a Settlement Class Member (e.g., phone records).
5.5 In order to receive a share of the Net Settlement Fund, Settlement Class Members must complete and timely submit a Claim Form, and that Claim Form must be validated by the Claims Administrator as provided in Section 5.7 below. Cl...
Submission of Claim Forms. 13 Class Members who seek monetary damages must complete a claim form and 14 cause it to be filed with the Claims Administrator by the claim filing deadline set forth in 15 the Preliminary Approval Order. The claim form must be postmarked or submitted 16 online on or before such date in order to be considered timely. All claim forms must be 17 signed under penalty of perjury to be considered. Failure to file a timely claim form, for 18 any reason whatsoever, shall bar the potential Class Member from having his or her claim
Submission of Claim Forms. Class Members who wish to receive payment under 6 the Settlement shall complete, sign, and return their Claim Form in accordance with the instructions 7 contained therein. Unless the Court orders otherwise, all Claim Forms must be postmarked no later 8 than fifty (50) days before the Final Approval Hearing. If requested, any Official Documentation 9 required to support a Claim Form must be submitted no later than twenty-one (21) days after the 10 Claim Deadline. Any Class Member who does not timely and validly submit a Verified Claim 11 Form within the time provided shall be barred from receiving payment under the Settlement, unless 12 otherwise ordered by the Court, but shall nevertheless be bound by any Final Judgment entered by 13 the Court.
Submission of Claim Forms. As set forth in Section 5(F) and 5(G), each Potential Class Member on the class list will be sent a Claim Form and Release from the USPS after Final Approval Date. To receive a Settlement Share, a Potential Class Member must mail an executed Claim Form and Release to the Class Administrator, postmarked within forty-five (45) calendar days of the date the Claim Form and Release was mailed by the USPS. The Class Administrator’s determination of which individuals have submitted timely Claim Form and Releases shall be final and unreviewable. Submission of Claim Form and Releases after the above-specified deadline will be accepted as timely by the Class Administrator if the Eligible Class Member filed a timely appeal of the Final Approval to the EEOC OFO. No Claim Form will be accepted as timely after the Effective Date, except that Eligible Class Members, who file timely appeals of the Final Approval to the EEOC OFO, can file Claim Form and Releases postmarked within ten (10) calendar days of the issuance of an EEOC OFO Decision disposing of the appeal. See Section 3(G) above.
Submission of Claim Forms. 58. Payment to Class Members in Group 1 who do not timely request exclusion shall be paid the amount listed in the Group 1 Class Members List on or before the Claim Payment Deadline without the need to submit a Claim Form. Class Members in Groups 2, 3, 4, and 5 must timely submit a Claim Form as provided in this Section VII.
59. Any right to payments made under this Agreement shall inure solely to the benefit of Class Members and cannot be transferred or assigned to others, unless the assignment predates the date of this Agreement or is made in the ordinary course, such as a roofing company that takes an assignment from a Class Member in exchange for the repair of the damaged roof and right to make a subsequent replacement cost benefits claim. A valid assignment does not include third-party entities that purport to take class action assignments in exchange for cash 60. The Administrator will send a Claim Form in the format attached hereto at Exhibit A. To the extent reasonably practicable, the Claim Form will identify the named policyholders, the claim number, the date of loss and the location of the insured structure. In the event the Claim Form does not contain this information because it was obtained off the class settlement website or by way of telephone request to the Administrator, the policyholder will be asked to provide the following information to the extent available to the policyholder: named policyholders, claim number, policy number, date of loss and/or location of insured structure.
Submission of Claim Forms. To receive an Individual Settlement Payment from the Net 1 Settlement Amount, a Settlement Class Member must timely submit a Claim Form that satisfies the 2 requirements of this paragraph as detailed below, must not have submitted a request for exclusion, and must be 3 eligible for a payment under the formula established in paragraph 42. A Claim Form is timely if it is postmarked 4 by the Response Date and mailed or submitted as an attachment to an email to the Claims Administrator at the 5 address in the Class Notice, or if it is submitted online to the Claims Administrator, in accordance with the 6 online submission instructions to be provided by the Claims Administrator, by the Response Date. The Claim 7 Form must be signed (electronically, if submitted via online portal) under penalty of perjury. To be valid, a 8 Claim Form must be signed without any deletion or amendment to its language. Settlement Class Members 9 who timely submit a Claim Form will receive their proportionate share of the Net Settlement Amount. No
Submission of Claim Forms. The content of Claim Forms shall be governed by the Claims Administration Process and this Settlement Agreement. Each Claim Form shall be signed by the Settlement Class Member and submitted to the Claims Administrators in accordance with the Claims Administration Process.
5.4.1 All statements made in Claim Forms, any acknowledgement forms, and certifications from healthcare providers and pharmacies shall be sworn statements under penalty of perjury.
5.4.2 Each Settlement Class Member must submit to the Claims Administrators all applicable documents required by the Claims Administration Process in order to receive a Monetary Award. A Settlement Class Member’s submission of an incomplete Claim Form may result in ineligibility for, or a reduction of, any Monetary Award to such Settlement Class Member.
5.4.3 Each Settlement Class Member who does not timely and properly Opt Out from the Settlement Class and submits a Claim Form will be entitled to apply for all compensation and benefits for which they qualify under the terms of the Claims Administration Process, but will be barred permanently and forever from commencing, filing, initiating, prosecuting, asserting, and/or maintaining any and all Released Claims against any Released Parties in any court of law or equity, arbitration tribunal, or administrative or other forum. If any Settlement Class Member has an objection, it shall be presented to the Court for final determination and the individual Settlement Class Member shall have no further reconsideration or appellate rights as to such Settlement Class Member’s Monetary Award.
5.4.4 The Claims Administrators and Settlement Administrator, and their respective agents, representatives, and professionals who are administering the Settlement, will have access to all information submitted by Settlement Class Members to the Claims Administrators and/or the Settlement Administrator necessary to perform their responsibilities under this Settlement Agreement.
5.4.5 Each Settlement Class Member will promptly notify the Claims Administrators of any changes or updates to the information the Settlement Class Member has provided in the Claim Form, including any change in mailing address.
Submission of Claim Forms. 1. The Settlement Administrator shall maintain and administer a dedicated settlement website (▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇) containing claims information and related documents, along with an electronic version of the Claim Form that Settlement Class A Members can view, complete, and submit electronically, as discussed below. The Parties shall agree on all information and documents to be posted on this website.
Submission of Claim Forms. Class Members who wish to receive a Claim Type 1 or Claim Type 2 payment under the Settlement shall complete, sign and return their Claim Forms in accordance with the instructions contained therein. Unless the Court orders otherwise, all Claim Forms must be submitted electronically or postmarked no later than sixty (60) days after the Mail Notice Deadline and no later than thirty (30) days prior to the Final Approval Hearing, or as the Bankruptcy Court may otherwise direct (the “Claim Deadline”). Any Class Member who does not timely and validly submit a Claim Form within the time
Submission of Claim Forms. Employees have a responsibility to provide information required to support their claim for FECA benefits including submission of appropriate forms to the applicable Employee Compensation Office (Code 1116) for submission to Office of Workers’ Compensation Program (OWCP). Employees may review their compensation records retained by the Employer.