Common use of Claim Assessment Clause in Contracts

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. (a) 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) 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 CertificateSchedule, then the Variable Medical Expenses payable shall be pro- pro-rated as per the applicable limits in accordance with Clause 2.1(iii) (a) & (b). (ii) If any sub-limits on Room Rent/Category for Medical Expenses are applicable as specified in the Policy Schedule, the Company’s liability to make payment shall be limited to the extent of the applicable sub-limit for that Medical Expense. (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.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 Clauseexceeded. (iv) Co-payment (if applicable) shall be applicable on the admissible claim amount payable by the Company Company (v) The balance amount, if any, subject to the applicability of sub-limits on Expenses in accordance with Clause 2.1 (iii) (c ) , the Company’s liability to make payment shall be limited to such extent as specified in applicable and shall be the Policy CertificateClaim payable. (c) c. The Claim amount assessed in Clause 6.6 5.6 (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. (a) 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) 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). (ii) If any sub-limits on Room Rent/Category for Medical Expenses are applicable as specified in the Policy Certificate, the Company’s liability to make payment shall be limited to the extent of the applicable sub-limit for that Medical Expense. (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 (if applicable) shall be applicable on the admissible claim amount payable by the Company as specified in the Policy Certificate.Company (c) c. The Claim amount assessed in Clause 6.6 5.6 (b) above would be deducted from the following amounts in the following progressive order: (i) Sum Insured; (ii) No Claims Bonus (if applicable); (iii) 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) d. All claims incurred in India are dealt by the Company directly.