CLAIM DOCUMENTS. We shall be provided the following necessary information and documentation in respect of all Claims within 30 days of the Insured Person’s discharge from Hospital. For Claims under which the use of Cashless Facility has been approved, We will be provided with these documents by the Network Provider immediately following the Insured Person’s discharge from Hospital:
(a) Xxxx completed Claim form signed by You and the Medical Practitioner (only for reimbursement claims);
(b) Original Pre – authorization request
(c) Copy of Pre – authorization approval letter
(d) Copy of the photo identity document of the Insured Person;
(e) Original bills, receipts and discharge certificate/card from the Hospital/Medical Practitioner;
(f) Original bills from chemists supported by proper prescription;
(g) Original investigation test reports (including CT/MR/USG/ECG, as applicable) and payment receipts;
(h) Indoor case papers (if available);
(i) Medical Practitioner’s referral letter advising Hospitalization in non-Accident cases and referral slip for all investigations carried out;
(j) Hospital discharge summary;
(k) FIR (if done) or MLC (if conducted) for Accident cases
(l) Post mortem report (if applicable and conducted);
(m) Any other document as required by Us or Our TPA to investigate the Claim or Our obligation to make payment for it.
CLAIM DOCUMENTS. We shall be provided the following necessary information and documentation in respect of all Claims within 30 days of the Insured Person’s discharge from Hospital. For Claims under which the use of Cashless Facility has been approved, We will be provided with these documents by the Network Provider immediately following the Insured Person’s discharge from Hospital:
(a) Xxxx completed Claim form signed by You and the Medical Practitioner (only for reimbursement claims);
(b) Original Pre – authorization request
(c) Copy of Pre – authorization approval letter
(d) Copy of the photo identity document of the Insured Person;
(e) Original bills, receipts and discharge certificate/card from the Hospital/Medical Practitioner;
CLAIM DOCUMENTS. The insured applying for proceeds shall attach the following documents:
1. Application for policy proceeds.
2. Any tickets/receipts of transportation or boarding pass.
3. Proofing documents which state the duration of and reason for delay from the transportation operator.
CLAIM DOCUMENTS. The insured applying for proceeds shall attach the following documents:
a. Application for policy proceeds.
b. Attestation of report to the Police.
c. List of losses.
CLAIM DOCUMENTS. In the event of a claim arising out of any of the listed Critical Illnesses covered under this Policy, the claim documents shall be submitted to Us within ninety (60) days of the date of first diagnosis of the Critical Illness/date of Surgical Procedure, as the case may be. The following documents shall be submitted in original for assessment and upon request We will return the original documents. ▪ Claim form duly filled and signed Part A and B wherever applicable; ▪ Medical Certificate confirming the diagnosis of Critical Illness; ▪ Certificate from attending Medical Practitioner confirming that the claim does not relate to any Pre-existing Illness or Injury or any Illness or Injury which was diagnosed within the first 90 days of the Inception of the Policy. ▪ Discharge Card/Death Summary from the Hospital, if applicable; ▪ Investigation test reports confirming the diagnosis as specified under the definition of the respective Critical Illnesses; ▪ First consultation letter and subsequent prescriptions; ▪ Indoor case papers if applicable; ▪ KYC documents; ▪ Specific documents listed under the respective Critical Illness ▪ Any other necessary documents as may be required by Us; ▪ In the cases where Critical Illness arises due to an accident, FIR copy or medico legal certificate will also be required wherever conducted. We may call for any additional necessary documents/information as required based on the circumstances of the claim. In case You delay submission of claim documents, then in addition to the documents mentioned above, You are also required to provide Us the reason for such delay in writing. We will accept such requests for delay up to an additional period of 30 days from the stipulated time for such submission. We will condone delay on merit for delayed Claims where the delay has been proved to be for reasons beyond Your/Insured Persons control.
CLAIM DOCUMENTS. All correspondence, purchase orders, purchase agreements, sales orders, sale agreements, test reports, internal memoranda, return/repair authorization acknowledgments, and any other documentation relating to any claim listed on Schedule B.
CLAIM DOCUMENTS. The following documents are to be provided in support of the Claim
(a) Duly Completed claim form (b) F.I.R.
(c) Death certificate from a competent authority designated by State Government.
(d) Postmortem reports or Panchanama.
(e) Certificate from designated Nodal Officer confirming the status of the claimant.
(f) Any other relevant and material document or information that IFFCO TOKIO deem fit and proper.
