Notice of claim
In the case of Emergency or Specialist Services, written notice of claim must be given to the insurer within twenty days after the occurrence or commencement of any loss covered by the Contract, or as soon thereafter as is reasonably possible. Notice given by or on behalf of the insured or the beneficiary to the Administrator at 12898 Towne Center Drive, Cerritos, CA 90703, or to any other authorized agent of the insurer, with information sufficient to identify the insurer, shall be deemed notice to the insurer.
Claim forms
The Administrator, upon receipt of a notice of claim, will furnish to the claimant such forms as are usually furnished by it for filing proofs of loss. If claim forms are not furnished within 15 days after the giving of notice, the claimant shall be deemed to have complied with the requirements of this contract as to proof of loss upon submitting, within the time fixed in the Contract for filing proof of loss, written proof covering the occurrence, the character and the extent of the loss for which claim is made.
Proof of loss
Claims for covered Emergency Dental Services or preauthorized Specialized Services should be sent to us, at the address on the back cover of this Contract, within 90 days of the end of treatment. Valid claims will be reviewed after 90 days if you can show that it was not reasonably possible to submit the claim within that time. Late claims must be submitted as soon as possible. All claims must be received within one year of the treatment date except in the absence of legal capacity of the claimant.
Time of payment of claims
Indemnities payable under this Contract for any loss will be paid immediately upon receipt of due written proof of such loss. |
