10. 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 date of Diagnosis or within 180 days of the initial Treatment of the Critical Illness. 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 date of Diagnosis of the Critical Illness. 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 the individual is legally incompetent. What is considered Proof of claim? Proof of claim must consist of at least the following information: · a description of the Critical Illness; · the date the Diagnosis occurred; · the cause of the Critical Illness; and · any other information we may require to make a claim determination. Proof of claim may include, but is not limited to, police accident reports, laboratory results, toxicology results, hospital records, x-rays, narrative reports, or other diagnostic testing materials, as required. 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? Claims that are not processed promptly will accrue simple interest at the rate required by Indiana law. Under a clean claim, interest will accrue from: · the 46th day we receive first proof of claim in writing; or · the 31st day after we receive the first proof of claim by electronic means. A claim is considered "clean" when the first proof of claim is complete; no part of the claim is contested; and no other defect prevents prompt payment. A claim will also be considered "clean" when we fail to 16-SD-C-01 Page29