8. CLAIM PROVISIONS How is a claim submitted? To submit a claim, you or someone on your behalf must send us Written notice and Proof of claim on our form within the time limits specified. Your Employer has the notice and Proof of claim forms. NOTICE OF CLAIM When does Written notice of claim have to be submitted? Written notice of claim must be given to us no later than 90 days after the Insured’s date of loss. If notice cannot be given within the applicable time period, we must be notified as soon as it is reasonably possible. When we receive Written notice of claim, we will send the forms for Proof of claim. If the forms are not received within 15 days after Written notice of claim is sent, Proof of claim may be sent to us without waiting to receive the Proof of claim forms. PROOF OF CLAIM When does Written Proof of claim have to be submitted? Written Proof of claim must be given to us no later than 180 days after the Insured’s date of loss. If Proof cannot be given within the time limit, Proof must be given as soon as reasonably possible. Proof of claim may not be given later than one year after the time Proof is otherwise required unless you are legally incompetent. What is considered Proof of claim? Proof of claim must consist of at least the following information: · a description of the loss; · the date the loss occurred; · the cause of the loss; · hospital records, physician records, x-rays, narrative reports, or lab, toxicology or other diagnostic testing materials as appropriate for the Treatment of the Injury; · police accident reports; and · any other information we may require to make a claim determination. We may require as part of the Proof, authorizations to obtain medical and non-medical information. Proof must be satisfactory to us. PAYMENT OF BENEFITS When are benefits payable? Benefits are payable upon our receipt of satisfactory Proof of claim that establishes benefit eligibility according to the provisions of the Policy. When will a decision on your claim be made? We will send you a Written notice of our decision on your claim within a reasonable time after we receive the claim but not later than 45 days after receipt of a Written claim or 30 days after receipt of an electronic claim. If we cannot make a decision within 45 days after receiving your Written claim or within 30 days after receiving your electronic claim, we will request a 30 day extension as permitted by U.S. Department of Labor regulations. Any request for extension will specifically explain: · the standards on which entitlement to benefits is based; · the unresolved issues that prevent a decision on the claim; and · the additional information needed to resolve those issues. 16-AC-C-01 Page31