ClaimSecure™ Terms of Use
Effective date: November 2023
Use of our websites and mobile applications (collectively referred to as “Online Services”) are governed by the following Terms of use (“Terms”).
Please read these Terms carefully, as by using our Online Services, you are agreeing to them.
These Terms may change so we recommend you review them regularly.
If you disagree with these Terms, don't use our Online Services.
Certain Online Services have additional terms and conditions that apply to their use, which are provided at registration.
Limited license and use
You are granted a limited license to display the contents of the Online Services and you can print, download and use the materials on our Online Services only for informational and educational purposes, and for doing business with us.
You agree you won't directly or indirectly misuse our Online Services in any way, including by:
- Probing, scanning, or testing the vulnerability of any system or associated network.
- Breaching or otherwise circumventing any security or authentication measures.
- Accessing, tampering with, or using non-public or shared areas of our Online Services that you haven’t been invited to.
- Interfering with, degrading the performance of, or disrupting any user, host, or network.
- Intentionally sending a virus or a corrupt file, Trojan horse or worm; or performing any other activity with the intent to overload, flood, or spam any part of the Online Services.
- Accessing or searching our Online Services by any means other than our publicly supported interfaces (for example, “scraping”).
- Modifying the Online Services or any of its content.
- Sending unsolicited communications, promotions or advertisements, or spam through our Online Services or services.
- Sending altered, deceptive or false source-identifying information, including “spoofing” or “phishing.”
- Abusing our Online Services in any manner.
- Providing unauthorized access to our Online Services to others or accessing our Online Services on behalf of another person without appropriate authorization.
- Using the Online Services to store or transmit content or data that is invasive of privacy, infringing, obscene, libelous, or that is otherwise unlawful or tortious, or to carry out infringing or unlawful activities.
You’ll be responsible for and indemnify (reimburse) us for any costs, losses, expenses, damages, legal fees, liabilities, claims, demands, actions and settlement amounts resulting from or related to your misuse of our Online Services.
Products and services
All products and services are subject to the terms and conditions of any applicable contracts and laws.
Our products and services and those of other companies described on our Online Services are available only where they are allowed to be offered within Canada.
No personalized or professional advice provided
Our Online Services aren’t intended to provide you with any personalized financial or any other professional advice unless we specify.
Our Online Services are not intended to provide legal, accounting, tax, medical or other professional advice unless we specify.
The applicable laws of Ontario and Canada govern the use of our Online Services. Any legal actions arising out of the use of the Online Services must be started in Ontario.
Personal information
Personal information is information that either on its own or combined with other information allows you to be identified. Examples include your name and address, as well as more sensitive information such as your health and banking information.
ClaimSecure is committed to respecting your privacy by protecting your personal information in accordance with the terms of our Privacy Notice, located at https://www.claimsecure.com/privacy/. By accessing and using the Online Services, you agree to the Privacy Notice, as may be amended from time to time by ClaimSecure, without limitation or qualification.
User authentication and access
In order to verify your identity when requesting access to the Online Services, the Online Services may prompt you for certain personal information.
If the personal information entered is confirmed, access will be granted. You agree that the use of this electronic authentication procedure is equivalent legally to your written signature.
Should ClaimSecure, in its sole discretion, deem it necessary to receive additional personal information before accepting a transaction or transmission, or before granting access to an Online Service, you agree to provide such additional personal information. ClaimSecure may, at its sole discretion, alter, enhance, or amend the type and nature of the access information required to access any Online Service.
As an Online Service user, you are responsible for keeping all access information confidential and preventing its unauthorized use or disclosure. It is vital that you immediately notify the ClaimSecure Customer Response Centre, set out below, if you become aware that any or all of your access information has been disclosed to anyone else, obtained by anyone else, or may be known by anyone else, or that any unauthorized use of an Online Service may be occurring.
If you access an Online Service on behalf of another party, you confirm you are authorized to do so. You are responsible for, and you will indemnify (reimburse) us if the party you are acting on behalf of claims you were not authorized, or you submitted inaccurate information.
ClaimSecure will not be held responsible for any losses or damages which may be incurred by any person as a result of the use of access information that is not explicitly authorized by ClaimSecure. This includes any direct, indirect, special, consequential or exemplary damages, even if ClaimSecure has been advised of the possibility, including but not limited to lost profits, lost opportunities or business revenues, loss of goodwill, or failure to realize expected savings.
ClaimSecure eProfile™ and benefits plans
eProfile
If your association with your employer/plan sponsor terminates, you understand that your access to services previously provided by ClaimSecure and paid for by your employer/plan sponsor may change, subject to the terms and conditions imposed by your employer/plan sponsor and/or ClaimSecure. You may possibly be permitted to continue to use ClaimSecure eProfile to access services that you previously registered for and/or paid for.
ClaimSecure reserves the right to revoke or change the condition of your ClaimSecure eProfile account without notice.
Benefits Plans and Claims Submission
For the purposes of this section, the terms “Abuse,” “Fraud” and “Waste” are defined as:
“Abuse” means practices, services or actions that, although not Fraud, are inconsistent with sound medical, professional or business practice which result in unnecessary costs to a benefit plan member or eligible dependent, benefit plan or otherwise, including payments for benefits or services that are not medically necessary, fail to meet the standard for healthcare or which were not (wholly or partially) eligible health benefits for the benefit plan.
“Fraud” means an intentional act of deception, misrepresentation or concealment in order to gain something of value, including, for example, submitting claims for services not rendered, submitting claims for services at a higher rate than the actual provider costs, deliberately misrepresenting services, resulting in improper or overpayments to providers or benefit members.
“Waste” means an overutilization of healthcare services that, although not fraud and not the result of criminal action, might directly or indirectly result in unnecessary costs to the benefit plan, including, for example, waste arising from billing and payment errors.
In addition to these Terms generally, your use of your ClaimSecure eProfile account or the submission of online claims is subject to ClaimSecure’s rules and procedures, as may be amended from time to time by ClaimSecure. By accessing and using your ClaimSecure eProfile account or submitting an online claim, you agree to be bound by and comply with such rules and procedures.
As a user of an Online Service, and where you are a member of a benefit plan administered (wholly or partially) by ClaimSecure, you agree to submit to ClaimSecure only legitimate claims, containing only true and complete information and that are absent of any Fraud, Waste or Abuse. Claims not adhering to these Terms generally or the immediately foregoing sentence specifically may be denied and your coverage may be terminated.
You certify that you are authorized to disclose and receive information about your spouse and/or dependents for the purposes of assessing and paying a benefit, if any. You acknowledge that any reimbursement of the changes and explanation of such amounts paid will be provided to the benefit plan member.
ClaimSecure will conduct audits of claims submitted for purposes that include preventing and detecting Fraud, Waste and Abuse. ClaimSecure, and persons acting for ClaimSecure, may disclose information about claims, or any personal information contained in such claims, to employers/plan sponsors for the purposes of reporting Fraud, Waste and Abuse or suspicious claims. ClaimSecure, or persons acting on ClaimSecure’s behalf, may disclose information about claims to others without your knowledge or consent or the consent of the individual to whom the information relates, as permitted by law.
As a member of a benefit plan administered (wholly or partially by ClaimSecure), you are responsible for:
- Keeping confidential any personal identification code assigned by ClaimSecure. You are responsible for all online claim submissions using your personal identification code or personal information.
- Ensuring you are using the most up-to-date claim form before submitting a claim.
- Where an overpayment occurs, repaying the amount of the overpayment to ClaimSecure on ClaimSecure’s request. You agree that ClaimSecure may, at its sole discretion and without prior notice to you, deduct such overpayments from future claim payments that you would otherwise be eligible to receive.
- Retaining original claim receipt(s) for 12 months following the date of your online claim submissions(s).
- Where your claim is selected for audit, providing the original receipt(s) to ClaimSecure within 30 days. Failure to produce original receipts upon request may result in your access to online claims submission being terminated or notice to your employer/plan sponsor.
Banking information and direct deposit
Banking Information
By accessing the Online Services and by providing us with banking information, including financial institution number, transit number and bank account number, you represent and warrant that this information is accurate, complete and has been voluntarily supplied to us. ClaimSecure is not responsible for inaccurate or delayed payments resulting from incorrect banking information provided to us.
Direct Deposit – General
Direct deposit may be offered by ClaimSecure for your convenience. By enrolling in direct deposit, you expressly agree to have all payments resulting from an approved claim paid electronically into your designated bank account.
The timing of all direct deposit payments will be in accordance with the payment release schedules determined by ClaimSecure in its sole discretion from time to time.
If you elect to be paid by direct deposit, no explanation of benefits will be mailed to you. You may view or print your payment details by logging on to your ClaimSecure eProfile account. You will be sent an email communication to the email address on your ClaimSecure eProfile account that will advise you that a direct deposit payment has taken place, or that we encountered difficulties in completing a direct deposit payment to you. It is your responsibility to ensure that these email communications are received and reviewed in a timely fashion.
Your correct banking information is required to successfully transfer funds to your designated bank account. If your banking information changes, it is your responsibility to ensure that your ClaimSecure eProfile account is updated to reflect the correct and most up to date banking information. ClaimSecure is not responsible for missed payments to you or payments deposited into an incorrect bank account as a result of inaccurate information provided by you or the actions of third parties using your access information.
In order to protect the security of your personal banking information, we cannot alter your banking information or enroll you in the direct deposit program. If you require additional assistance, you can: (a) access your ClaimSecure eProfile account; (b) contact the ClaimSecure Customer Response Centre as set out below; or (c) contact your bank to determine your accurate banking information.
ClaimSecure reserves the right to cancel or suspend your enrollment in direct deposit for any reason, including as a result of a Fraud, Waste and Abuse investigation.
Where required by law, including as a result of court order, legal proceeding or similar action, ClaimSecure may redirect payments owing to you to alternate bank accounts. In such circumstances, deposits into such alternate bank accounts represent full payment to you.
Opting out of direct deposit
If you elect to change your payment method from direct deposit to cheque, the cheque will be sent to the mailing address that you have provided.
Any previous, unsuccessful payments made by direct deposit cannot be completed by cheque. You must correct your banking information in order to allow us to reprocess any direct deposit payment. Subsequent payments will be made by cheque.
Availability
Our Online Services, in whole or in part, may occasionally be unavailable because of maintenance, updates or other causes that may be beyond our control. Any or all of our Online Services may change at any time without notice. ClaimSecure may suspend any Online Services for any reason.
Copyright
Our Online Services were developed by ClaimSecure and are our property. All information and materials contained in our Online Services are protected by copyright, trademark and/or other intellectual property laws of Canada and other countries and are the property of their respective owner(s).
Subject to the limited license to use our Online Services, no one may copy, redistribute, reproduce or republish in any form, or link to our Online Services or its contents in any manner whatsoever, including by way of hyperlinks or framing, unless that person has obtained the prior written consent of ClaimSecure. Any infringement of the rights of ClaimSecure may result in legal action.
Trademarks
ClaimSecure owns or has obtained the right to use the trademarks, logos and domain names used on our Online Services. The trademarks are protected by Canadian and foreign trademark laws. All rights reserved.
The display of trademarks on our Online Services shouldn’t be construed as an implied license to use such trademarks.
ClaimSecure, the design, and marks displayed on the Online Services followed by the TM symbol at first time of use are registered or unregistered trademarks of ClaimSecure Inc. or a third party. Third-party marks are used with permission or under license.
General disclaimer
We do our best to make sure all the information on our Online Services is reliable and accurate, but we can’t guarantee it. If there’s any difference between the information provided on or through our Online Services and the information in our records, the information in our records prevails.
Unless we specify, nothing on our Online Services forms a contract except for the use of the Online Services.
If there’s any difference between the information on our Online Services and the terms of a product or service, we or a third-party offer, the terms for that product or service prevail.
We always try to make sure our Online Services are working at their best, but we can’t guarantee you won’t experience errors, interruptions or browser issues.
Links and references to other websites are provided as a convenience only. ClaimSecure does not expressly or implicitly endorse other websites or any informational content or material, or the accessibility thereof, via such links, and does not assume any responsibility for any such other websites, their content, or products or services offered thereon. ClaimSecure does not make any representations or warranties as to the security of any information, including personal information that you might be requested to give any third party.
ClaimSecure may utilize third-party service providers to provide certain tools or programs, some of which may be housed on a third-party server or at a website which has been independently developed by others. While accessing the Online Services, you may be linked to such other third-party servers. Access to these other websites or the use of any third-party tools or programs on the Online Services are subject to all the terms and conditions set out on such third-party websites, and ClaimSecure is not responsible for any loss that results from such access or use.
We cannot guarantee that communication to or from our Online Services is private, confidential or secure. We don’t make and expressly disclaim any representations or warranties whatsoever relating to or arising from your use of our Online Services.
You agree neither ClaimSecure nor any third party (including their employees, officers and directors) shall be liable to you for loss of data, computer time or any loss or damage of any nature whatsoever attributable to your use or inability to use the Online Services for any reason whatsoever or to any action or inaction on the part of ClaimSecure.
This includes any direct, indirect, special, consequential or exemplary damages, even if ClaimSecure has been advised of the possibility, including but not limited to lost profits, lost opportunities or business revenues, loss of goodwill, or failure to realize expected savings.
This agreement is binding on you, your heirs, executors, administrators, legal representatives, successors and assigns.
If anything in this agreement turns out to be unenforceable or invalid, the rest of it still applies.
More information
You may contact the ClaimSecure Customer Response Centre as follows:
- By telephone 1-888-513-4464
- By email at service@claimsecure.com
- By regular mail:
ClaimSecure Inc.
40 Elm St, Suite #225,
Sudbury, ON P3C 0A2
If you need an alternate way to contact us, visit our Accessibility page.
© 2023 CLAIMSECURE INC. ALL RIGHTS RESERVED.
