Rule 4717-14-13 | Application for reimbursement.
(A) The board shall create an application form for reimbursement which shall be submitted to the board office and require the following information:
(1) The name, address, and contact information of the applicant;
(2) The name, address, and contact information of the funeral home or funeral director, or both, who caused the loss;
(3) The amount of the alleged loss for which the application for reimbursement is made;
(4) A copy of the preneed funeral contract or written agreement which was the basis of the alleged loss;
(5) If the individual seeking reimbursement is deceased, a copy of the death certificate of the funeral recipient;
(6) Relationship to the funeral recipient;
(7) If applicable, a copy of the right of disposition;
(8) A general statement of the relevant facts causing the application for reimbursement;
(9) Supporting documents, including copies of court proceedings and other papers indicating the efforts of the applicant to obtain reimbursement from the provider, insurance companies, or others, any reimbursement received from the provider, insurance companies, or other funeral home;
(10) If applicable, the name and address of the funeral home that carried out the contract and provided services or merchandise or both following the loss;
(11) If applicable, proof of payment for the new preneed funeral contract;
(12) If applicable, name of the individual or individuals who purchased or contributed to the purchase of the new preneed funeral contract;
(13) If applicable, the name and address of the funeral home where a new preneed funeral contract was purchased following the loss from the initial contract.
(B) An applicant with multiple claims shall submit an application for reimbursement for each claim and include the information required by the board.
(C) Applicants with multiple individuals contributing to payment of a preneed contract shall submit one application for reimbursement and include the name of each individual that contributed to payment for the contract.
Last updated October 2, 2023 at 12:15 PM
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