CLAIMS PROVISIONS NOTICE OF CLAIM: Written notice must be given to us within 31 days after the service or event occurs for which claim may be made, or as soon as reasonably possible. The notice should be sent to us at our Administrative Offices or to our authorized agent. The notice should include the Policyholder's name, your or your Insured Dependent's name and the Policy Number. CLAIM FORMS: When we receive written notice of a claim, we will send claim forms to the claimant within 15 days. If we do not, the claimant will satisfy the requirements of written proof of loss by sending us written proof as shown below. The proof must describe the occurrence, extent and nature of the claim. PROOF OF CLAIM: We must be given written proof of claim within 90 days after the date of services or the occurrence of an event, or as soon as reasonably possible thereafter. In any event, proof of claim must be given within one year, unless the claimant is legally incapable of doing so. Proof of claim for any Covered Accident must include: (1) the nature and date of the claim and reason claim is being made; (2) a description of the event and/or services provided; and (3) proof that the services or event occurred. Such proof may take the form of a receipt for services or some other official documentation supporting the claim and which is acceptable to us. Within 15 days after receiving the first proof of claim, we may send a written acknowledgment. Such acknowledgment may request any missing information or other items we need in order to adjudicate your or your Insured Dependent's claim. Such information or items we may request may include, but are not limited to: (1) copies of x-rays or any other diagnostic tests performed; (2) copies of medical records or charts; or (3) any other information we may reasonably require. TIME OF PAYMENT OF CLAIMS: When we receive satisfactory written proof of loss, we will pay any benefits due. Benefits that provide for periodic payment will be paid accordingly. Simple interest will accrue on claims that are not processed promptly. The rate will be as required by Indiana law. Under a clean claim, interest will accrue from: (1) the 46th day after we receive the first proof of claim in writing; or (2) 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 promptly request more information or to resolve it, within 45 days after receiving a written claim or 30 days after receiving an electronic claim. Under a defective claim, interest will accrue from: (1) the 46th day after we receive enough proof to confirm liability, if the claim is filed in writing and we request more information within 45 days; or (2) the 31st day after we receive enough proof to confirm liability, if the claim is filed by electronic means and we request more information within 30 days. A claim is considered "defective" when the first proof of claim is incomplete; any part of the claim is contested; or some other defect prevents prompt payment. PAYMENT OF CLAIMS: If you die, we will pay any death benefit and any other accrued benefits in accordance with the Beneficiary and Facility of Payment provisions. All other benefits will be paid to you. Reliance Standard Life Insurance Company shall serve as the claims review fiduciary with respect to the insurance policy and the Plan. The claims review fiduciary has the discretionary authority to interpret the Plan and the insurance policy and to determine eligibility for benefits. Decisions by the claims review fiduciary shall be complete, final and binding on all parties. LRS-9548-0318-IN Page 10.0