Claim Intimation. Upon the discovery or occurrence of any Illness / Injury that may give rise to a Claim under this Policy, You / Insured Person shall undertake the following: In the event of any Illness or Injury or occurrence of any other contingency which has resulted in a Claim or may result in a claim covered under the Policy, You/the Insured Person, must notify Us either at the call center or in writing, in the event of: • Planned Hospitalization, You/the Insured Person will intimate such admission at least 3 days prior to the planned date of admission. • Emergency Hospitalization, You /the Insured Person will intimate such admission within 48 hours of such admission. The following details are to be provided to Us at the time of intimation of Claim: • Policy Number • Name of the Policyholder • Name of the Insured Person in whose relation the Claim is being lodged • Nature of Illness / Injury • Name and address of the attending Medical Practitioner and Hospital • Date of Admission • Any other information as requested by Us
Claim Intimation. In the event of any occurrence which may give rise to a claim under this Policy the Insured shall as soon as possible, and in any case within a period of thirty days of such occurrence, give notice thereof to the Company in writing with full particulars. Every letter claim writ summons and process shall be notified to the Company immediately on receipt. Notice shall also be given to the Company immediately the Insured shall have knowledge of any impending prosecution inquest or fatal enquiry in connection with any such occurrence as aforesaid.
Claim Intimation. Upon the discovery or occurrence of an Accident that may give rise to a Claim under this Policy, Insured Person or the Nominee as the case may be shall undertake the following: Notify Us either at the call centre or in writing, within 10 days from the date of occurrence of such Accident/diagnosis of a Critical Illness. The following details are to be provided to Us at the time of intimation of Claim:
Claim Intimation. Any intimation about a claim under the Policy shall be given in within 48 hours of admission but before discharge (in case of hospitalisation); and in all other cases within48 hours of the loss/accident.
Claim Intimation. The TPA shall process claims of which intimation may be received from the Insurer or the Insured Person. On receiving such intimation, the TPA shall advise the Insured Person of documents required for considering the claim and thereafter proceed to process the same. The TPA shall submit a daily report to respective Regional Office of the Insurer of claim intimations received. The weekly reports shall be sent by e-mail to each Underwriting Office and where such facility is not available it shall be sent by Post/fax. TPA must engage technically experienced employees to capture the data and upload to the CWISS system (NIA Core IT Program) on daily basis. It is responsibility of TPA to upload the changes in claims processed on day to day basis so that the Insurer shall be able to capture and view the status of the claim. The TPA shall be responsible to closely verify, monitor and confirm that charges levied by Hospitals in any claim are reasonable, warranted and necessary to ensure that claim cost is fair in the given circumstances. In network Hospital claims, TPA shall check for adherence to SOC and identify any deviations in the same. All deviations identified need to be confirmed from the hospital for justifications and clearly noted in remarks in the claim file. A detailed report of provider wise, ailment wise and other parameters which have shown deviations from the agreed SOCs need to be generated by the TPA on agreed frequency and submitted to the RO of the Insurer. For the said purpose the TPA shall, make expeditious visits to Hospitals on intimation of claim, hold consultations with the Doctors, Hospital staff and other persons as may be necessary and take all other such steps as required. The TPA will send a monthly report to the insurer on the number of visits made and details thereof.
Claim Intimation. Upon the discovery or occurrence of any event that may give rise to a Claim under this Policy, You / Insured Person or the Nominee as the case may be shall undertake the following: Notify Us either at the call center or in writing, within 10 days of from the date of diagnosis of such Critical Illness. The following details are to be provided to Us at the time of intimation of Claim: ▪ Policy Number ▪ Name of the Policyholder ▪ Name of the Insured Person in whose relation the Claim is being lodged ▪ Name of Critical Illness Event ▪ Name and address of the attending Medical Practitioner and Hospital (if admission has taken place) ▪ Date of Admission if applicable ▪ Any other information, documentation as requested by Us
