Common use of Claims Documentation Clause in Contracts

Claims Documentation. The Company shall be provided with the following necessary information and documentation in respect of all claims at Policyholder/ Insured Person’s expense within 30 days of the date of occurrence of an Insured Event or completion of Survival Period, at own expense to avail the Claim. a. Claim form duly completed and signed by the Insured Person. Please provide mandatorily following information if applicable i. Current diagnosis and date of diagnosis; ii. Past history and first consultation details; iii. Previous admission/Surgery if any. b. Age/Identity proof document of the Proposer. i. Self attested copy of valid Age proof (passport / driving license / PAN card / class X certificate / birth certificate); ii. Self attested copy of identity proof (passport / driving license / PAN card / voter identity card); iii. Recent passport size photograph. c. Cancelled cheque/ bank statement / copy of passbook mentioning account holder’s name, IFSC code and account number printed on it of Insured Person / nominee ( in case of death of Insured Person). d. Original discharge summary.(if applicable) e. Additional documents required in case of Surgery/Surgical Procedure (If applicable) i. Bar code sticker and invoice for implants and prosthesis (if used); f. Original final ▇▇▇▇ from Hospital with detailed break-up and paid receipt. (If applicable) g. Copy of death certificate (in case of demise of the Insured Person). h. For Medico-legal cases (MLC) or in case of Accident as may be applicable i. MLC and First Information Report (FIR) copy duly attested by the concerned Hospital and police station respectively. (if applicable); ii. Original self-narration of incident in absence of MLC/ FIR. i. Original laboratory investigation, diagnostic & pathological reports with supporting prescriptions. j. Original X-Ray/ MRI / ultrasound films and other radiological investigations. In the event of death of the Insured Person post the survival period, the immediate family member/relative of the Insured Person claiming on Insured Person’s behalf must inform the Company in writing immediately and send a copy of all the required documents to prove the cause of death within 30 days of the death. Company upon acceptance of the admission of claim under the Policy shall make payment to the Insured Person or Nominee/legal heirs of the Insured Person, in case of the death of the Insured Person post the survival period.

Claims Documentation. The Company We shall be provided with the following necessary information and documentation in respect of all claims at Policyholder/ Your/Insured Person’s expense within 30 days of the date Insured Person’s discharge from Hospital (in the case of occurrence Pre-hospitalization Medical Expenses and Hospitalization Medical Expenses) or within 30 days of an Insured Event or the completion of Survival Periodthe Post-hospitalization Medical Expenses period (in the case of Post-hospitalization Medical Expenses). For those claims for which the use of Cashless Facility has been authorised, at own expense to avail We will be provided these documents by the Claim.Network Provider immediately following the Insured Person’s discharge from Hospital: a. Claim form duly completed and signed by the Insured Personclaimant. Please provide mandatorily following information if applicable i. Current diagnosis and date of diagnosis; ii. Past history and first consultation details; iii. Previous admission/Surgery if any. b. Age/Identity proof document document: Of Insured Person in case of cashless claim (not required if submitted at the Proposertime of pre-authorization request) and Proposer in case of Reimbursement claim. i. Self attested copy of valid Age proof (passport / driving license / PAN card / class X certificate / birth certificate); ii. Self attested copy of identity proof (passport / driving license / PAN card / voter identity card); iii. Recent passport size photograph. c. Cancelled cheque/ bank statement / copy of passbook mentioning account holder’s holder‟s name, IFSC code and account number printed on it of Insured Person Policyholder / nominee ( in case of death of Insured PersonPolicyholder). d. Original discharge summary.(if applicable)summary. e. Additional documents required in case of Surgery/Surgical Procedure (If applicable)Procedure. i. Bar code sticker and invoice for implants and prosthesis (if used); f. Original final ▇▇▇▇ bill from Hospital with detailed break-up and paid receipt. g. Room tariff of the entitled room category (in case of a Non-Network provider and if room tariff is not a part of Hospital bill): duly signed and stamped by the Hospital in which treatment is taken. (If applicableIn case You are unable to submit such document, then We shall consider the Reasonable and Customary Charges of the Insured Person’s eligible room category of Our Network Provider within the same geographical area for identical or similar services.) g. h. Original bills of pharmacy/medicines purchased, or of any other investigation done outside Hospital with reports and requisite prescriptions. i. Copy of death certificate (in case of demise of the Insured Person). h. j. For Medico-legal cases (MLC) or in case of Accident as may be applicableAccident i. MLC and MLC/First Information Report (FIR) copy duly attested by the concerned Hospital and / police station respectively. (if applicable); ii. Original self-narration of incident in absence of MLC/ MLC / FIR. i. k. Original laboratory investigation, diagnostic & pathological reports with supporting prescriptions. j. l. Original X-Ray/ MRI / ultrasound films and other radiological investigations. In the event of death of the Insured Person post the survival periodPerson's death during Hospitalization, the immediate family member/relative of the Insured Person claiming on Insured Person’s behalf must inform the Company in writing immediately and send written notice accompanied by a copy of all the required documents post mortem report (if any) shall be given to prove the cause Us regardless of death within 30 days of the death. Company upon acceptance of the admission of claim under the Policy shall make payment whether any other notice has been given to the Insured Person or Nominee/legal heirs of the Insured Person, in case of the death of the Insured Person post the survival periodUs.

Claims Documentation. The Company We shall be provided with the following necessary information and documentation in respect of all claims at Policyholder/ Your/Insured Person’s expense within 30 days of the date Insured Person’s discharge from Hospital (in the case of occurrence Pre-hospitalization Medical Expenses and Hospitalization Medical Expenses) or within 30 days of an Insured Event or the completion of Survival Periodthe Post-hospitalization Medical Expenses period (in the case of Post-hospitalization Medical Expenses). For those claims for which the use of Cashless Facility has been authorised, at own expense to avail We will be provided these documents by the Claim.Network Provider immediately following the Insured Person’s discharge from Hospital: a. Claim form duly completed and signed by the Insured Personclaimant. Please provide mandatorily following information if applicable i. Current diagnosis and date of diagnosis; ii. Past history and first consultation details; iii. Previous admission/Surgery if any. b. Age/Identity proof document document: Of Insured Person in case of cashless claim (not required if submitted at the Proposertime of pre-authorization request) and Proposer in case of Reimbursement claim. i. Self attested copy of valid Age proof (passport / driving license / PAN card / class X certificate / birth certificate); ii. Self attested copy of identity proof (passport / driving license / PAN card / voter identity card); iii. Recent passport size photograph. c. Cancelled cheque/ bank statement / copy of passbook mentioning account holder’s holder‟s name, IFSC code and account number printed on it of Insured Person Policyholder / nominee ( in case of death of Insured PersonPolicyholder). d. Original discharge summary.(if applicable)summary. e. Additional documents required in case of Surgery/Surgical Procedure (If applicable)Procedure. i. Bar code sticker and invoice for implants and prosthesis (if used); f. Original final ▇▇▇▇ from Hospital with detailed break-up and paid receipt. g. Room tariff of the entitled room category (in case of a Non-Network provider and if room tariff is not a part of Hospital ▇▇▇▇): duly signed and stamped by the Hospital in which treatment is taken. (If applicableIn case You are unable to submit such document, then We shall consider the Reasonable and Customary Charges of the Insured Person’s eligible room category of Our Network Provider within the same geographical area for identical or similar services.) g. h. Original bills of pharmacy/medicines purchased, or of any other investigation done outside Hospital with reports and requisite prescriptions. i. Copy of death certificate (in case of demise of the Insured Person). h. j. For Medico-legal cases (MLC) or in case of Accident as may be applicableAccident i. MLC and MLC/First Information Report (FIR) copy duly attested by the concerned Hospital and / police station respectively. (if applicable); ii. Original self-narration of incident in absence of MLC/ MLC / FIR. i. k. Original laboratory investigation, diagnostic & pathological reports with supporting prescriptions. j. l. Original X-Ray/ MRI / ultrasound films and other radiological investigations. In the event of death of the Insured Person post the survival periodPerson's death during Hospitalization, the immediate family member/relative of the Insured Person claiming on Insured Person’s behalf must inform the Company in writing immediately and send written notice accompanied by a copy of all the required documents post mortem report (if any) shall be given to prove the cause Us regardless of death within 30 days of the death. Company upon acceptance of the admission of claim under the Policy shall make payment whether any other notice has been given to the Insured Person or Nominee/legal heirs of the Insured Person, in case of the death of the Insured Person post the survival periodUs.