CLAIM INFORMATION HC13GPIN 23 B-21113 (11/25) NOTICE OF CLAIM We encourage you to notify us of your claim as soon as possible so that a claim decision can be made in a timely manner. Written notice of claim should be given to us within 30 days after the date your disability begins. The notice may be given to us at our home office or to our authorized agent or administrator. Failure to give notice within this timeframe will not invalidate or reduce any payable claim if it can be shown that it was not reasonably possible to give such notice within that time and the notice was given as soon as reasonably possible. The claim form is available from the Policyholder or you can request a claim form from us. If you do not receive the form from us within 15 days of your request, send us written proof of claim without waiting for the form. You must notify us immediately when you return to work in any capacity. FILING A CLAIM You and your Employer must fill out your own sections of the claim form and then give it to your attending doctor. Your doctor should fill out his or her section of the form and send it directly to us. PROOF OF YOUR CLAIM You must send us written proof of your claim no later than 90 days after your elimination period ends. Failure to give such proof within this timeframe will not invalidate or reduce any payable claim if it can be shown that it was not reasonably possible to give such proof within that time, and the proof was given as soon as reasonably possible. You must provide proof of claim no later than 1 year after the time proof is otherwise required, except in the absence of legal capacity. Your proof of claim, provided at your expense, must show all of the following: • That you are under the appropriate care of a doctor. • The date your disability began. • The cause of your disability. • The appropriate documentation of your earnings and your activities. • The extent of your disability, including restrictions and limitations preventing you from performing your regular occupation. • The name and address of any hospital, health facility or institution where you received treatment, including all attending doctors. • Documentation of prior disability coverage, if applicable. In some cases, you will be required to give us authorization to obtain additional medical information, and to provide non-medical information as part of your proof of claim, or proof of continuing disability. We will deny your claim, or stop sending you payments, if the appropriate information is not submitted within 45 days of the request. You must notify us immediately when you return to work in any capacity. MAKING PAYMENTS Once your claim has been approved, we will send you a payment at the end of each month for any period for which we are liable. Any balance remaining unpaid at the termination of a period of disability will be paid immediately upon receipt of your proof of claim. OVERPAID CLAIMS We have the right to recover any overpayments due to any of the following: • Fraud. • Any administrative error we make in processing a claim. • Your receipt of deductible sources of income.