Claim Assessment. We will assess all admissible claims under the Policy in the following progressive order –
Claim Assessment. (a) The Company shall scrutinize the Claim and supportive documents, once received. In case of any deficiency, the Company may call for any additional documents or information as required, based on the circumstances of the Claim.
(b) All admissible Claims under this Policy shall be assessed by the Company in the following progressive order:
(i) If the provisions of the Contribution Clause in Clause 7.9 are applicable, the Company’s liability to make payment under that Claims shall first be apportioned accordingly.
(ii) If a Room/ICU accommodation has been opted for where the Room Rent or Room Category or ICU Charges is higher than the eligible limit as applicable for that Insured Person as specified in the Policy Certificate, then the Variable Medical Expenses payable shall be pro- rated as per the applicable limits in accordance with Clause 2.1(iii) (a) & (b).
(iii) The Deductible (if applicable) shall be applied to the aggregate of all Claims that are either paid or payable under this Policy. The Company’s liability to make payment shall commence only once the aggregate amount of all Claims payable or paid exceed the Deductible where the Claim amount is within the Deductible, the Company will not apply the Contribution Clause. Similarly, if ‘Deductible per claim’ is applicable, the Company’s liability to make payment shall commence only once the ‘Deductible per claim’ limit is exceeded and the Company will not apply the Contribution Clause.
(iv) Co-payment shall be applicable on the amount payable by the Company as specified in the Policy Certificate.
(c) The Claim amount assessed in Clause 6.6 (b) above would be deducted from the following amounts in the following progressive order:
(i) Sum Insured;
(ii) Additional Sum Insured for Accidental Hospitalization (if applicable);
(iii) No Claims Bonus (if applicable);
(iv) No Claims Bonus Super (if applicable);
(v) Automatic Recharge (if applicable);
(vi) Unlimited Automatic Recharge (if applicable).
(d) All claims incurred in India are dealt by the Company directly.
Claim Assessment. The Seller’s assessment of the Warranty Claim will be reasonably based upon the details given in the Warranty Claim, reports from the Seller’s local representative, historical data logs, inspection, tests, findings during repair, defect analysis and other suitable documents; The Seller will notify the Buyer of its decision on this Warranty Claim within [CONFIDENTIAL MATERIAL OMITTED AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT] of receiving such. If no response is received from the Seller within this period, the Warranty Claim will be considered to have been accepted by the Seller. Any credit will be issued within a maximum period of [CONFIDENTIAL MATERIAL OMITTED AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT] following the Seller’s response.
Claim Assessment a. All admissible Claims under this Policy shall be assessed by the company.
b. The Claim amount assessed would be deducted from the following amounts in the following progressive order:
i. Sum Insured;
ii. Reinstatement of Sum Insured (if applicable).
Claim Assessment a. The Company shall scrutinize the Claim and supportive documents, once received. In case of any deficiency, the Company may call for any additional documents or information as required, based on the circumstances of the Claim.
b. All admissible Claims under this Policy shall be assessed by the Company in the following progressive order:
(i) If a Room/ICU accommodation has been opted for where the Room Rent or Room Category or ICU Charges is higher than the eligible limit as applicable for that Insured Member as specified in the Certificate of Insurance, then the Variable Medical Expenses payable shall be pro-rated as per the applicable limits as specified in the Certificate of Insurance.
(ii) If any sub-limits on Medical Expenses are applicable as specified in the Certificate of Insurance, the Company’s liability to make payment shall be limited to the extent of the applicable sub-limit for that Medical Expense.
(iii) Co-payments and Deductibles, if any, shall be applicable on the amount payable by the Company after applying Clause 5.5.(b)(i), (ii).
c. The Claim amount assessed in Clause 5.5 (b) above would be deducted from the following:
i) Coverage Amount of respective Optional Benefit or Optional Cover.
ii) No Claims Bonus (if applicable)
d. All claims incurred in India are dealt by the Company directly
Claim Assessment. We will pay fixed benefit amounts as specified in the Schedule to this Policy in accordance with the terms of this Policy. We are not liable to make any reimbursements of Medical Expenses or pay any other amounts not specified in the Policy.
Claim Assessment. We will pay fixed or indemnity amounts as specified in the applicable for Basic or Optional Benefits in accordance with the terms of this Policy. If the provisions of the Contribution Clause apply in respect of an indemnity cover, (as per provisions of Section IV.18), Our liability to make payment under the claim shall be first apportioned accordingly. For Group Critical Illness Claims, if Lump sum Pay out is opted at the time of Policy inception then full Sum Insured will be paid at one time and the claim will be settled. In case Staggered Pay out option is opted, on occurrence of a covered Critical Illness Event - 25% of Sum Insured will be paid as Lump sum. The balance 75% + 10% additional Sum Insured will be paid in 60 equated monthly instalments starting from beginning of the next month. We are not liable to make any payments that are not specified in the Policy.
Claim Assessment. We will pay fixed or indemnity amounts as specified in the applicable for Basic or Optional Benefits in accordance with the terms of this Policy. For Group Critical Illness Claims, if Lump sum Pay out is opted at the time of Policy inception then full Sum Insured will be paid at one time and the claim will be settled. We are not liable to make any payments that are not specified in the Policy.
Claim Assessment. The Policy holder or their representative undertakes to supply the Insurer all the documents making it possible to assess whether the declared claim is covered by the insurance. If the Policy holder or their representative refuses to communicate documents or refuse to undergo a medical examination by a medical expert appointed by the Insurer without a valid reason, and if after having been notified 48 hours in advance by registered letter they continue to refuse, the Policy holder or the Beneficiary/Beneficiaries shall forfeit all right to compensation. If additional medical documents or any other documentary proof is found to be necessary to the determination of their rights, the Policy holder or their legal representative will be notified of the fact by letter. If an expertise is required to process the Claim and if the Policy holder or their legal representative refuse to submit to it without a valid reason, and if, after having been notified forty eight hours in advance by registered letter, they continue to refuse, the Insurer will be forced to defer the payment of any compensation for the Claim in question.
Claim Assessment. We will pay fixed compensation as per the Sum Insured stated in the Policy, once the Insured Person suffers Illness/Injury/medical condition which shall lead to the diagnosis of any of the named Critical Illnesses. For Lump sum Pay out the full Sum Insured will be paid at one time and the claim will be settled. In case of Staggered Pay out option, on occurrence of a covered Critical Illness Event - 25% of Sum Insured will be paid as Lump sum. The balance 75% + Additional 10% of Sum Insured will be paid in 60 equated monthly instalments starting from beginning of the next month. - In case of a claim, an amount equivalent to the balance of the instalment premiums payable, in that policy year would be recoverable from the claim amount payable in respect of the Insured person.
