Long Term Disability Summary Plan Description

SECTION 7 - GENERAL PROVISIONS (Continued)

When Must Liberty be Notified of a Claim? 1. Notice of claim must be given to Liberty within 20 days of the date of the loss on which the claim is based. If that is not possible, Liberty must be notified as soon as it is reasonably possible to do so. Such notice of claim must be received in a form or format satisfactory to Liberty. 2. When written notice of claim is applicable and has been received by Liberty, you will be sent claim forms. If the forms are not received within 15 days after written notice of claim is sent, you can send to Liberty written Proof of claim without waiting for the forms. When Must Liberty Receive Proof of Claim? 1. Satisfactory Proof of loss must be given to Liberty no later than 30 days after the end of the Elimination Period. 2. Failure to furnish such Proof within such time shall not invalidate or reduce any claim if it was not reasonably possible to furnish such Proof within such time. Such Proof must be furnished as soon as reasonably possible, and in no event, except in the absence of legal capacity of the claimant, later than one year from the time Proof is otherwise required. 3. Proof of continued loss, continued Disability or Partial Disability, when applicable, and Regular Attendance of a Physician must be given to Liberty within 30 days of the request for such Proof. Liberty reserves the right to determine if your Proof of loss is satisfactory. Who are Claims Paid To? The benefit is payable to you. But, if a benefit is payable to your estate, or if you are a minor, or you are not competent, Liberty has the right to pay up to $1,000 to any of your relatives or any other person whom Liberty considers entitled thereto by reason of having incurred expense for the maintenance, medical attendance or burial. If Liberty in good faith pays the benefit in such a manner, any such payment shall fulfill Liberty's responsibility for the amount paid. What are Liberty's Rights of Recovery? Liberty has the right to recover any overpayment of benefits caused by, but not limited to, the following: 1. fraud; 2. any error made by Liberty in processing a claim within 15 months beginning on the date the claim was paid; or 3. your receipt of any Other Income Benefits. Liberty may recover an overpayment by, but not limited to, the following: 1. requesting a lump sum payment of the overpaid amount; 2. reducing any benefits payable under this policy; 3. taking any appropriate collection activity available including any legal action needed; and 4. placing a lien, if not prohibited by law, in the amount of the overpayment on the proceeds of any Other Income Benefits, whether on a periodic or lump sum basis. It is required that full reimbursement be made to Liberty.

ADOC-GNP-2.16

General Provisions

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