Claims Documentation Sample Clauses
Claims Documentation. We shall be provided with the following necessary information and documentation in respect of all claims at Your/Insured Person’s expense within 30 days of the Insured Person’s discharge from Hospital (in the case of Pre-hospitalization Medical Expenses and Hospitalization Medical Expenses) or within 30 days of the completion of the 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, We will be provided these documents by the Network Provider immediately following the Insured Person’s discharge from Hospital:
a. Claim form duly completed and signed by the claimant. 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.
Claims Documentation. We or the associated TPA shall be provided the following necessary information and documentation in respect of all claims at the Insured Person’s expense within 30 days of the Insured Person’s discharge from the Hospital:
(i) Claims for Pre-hospitalization Medical Expenses and Post- hosptialization Medical Expenses to be submitted to us within 30 days of the completion of the post- Hospitalisation treatment
(ii) For those claims for which the use of Cashless Facility has been authorised, We will be provided these documents by the Network Provider immediately following the Insured Person’s discharge from the Hospital:
(1) Duly completed claim form;
(2) Photo ID and Age proof;
(3) Health Card, policy copy, photo ID, KYC documents;
(4) Original discharge card / day care summary / transfer summary;
(5) Original final Hospital bill with all original deposit and final payment receipt;
(6) Original invoice with payment receipt and implant stickers for all implants used during Surgeries i.e. lens sticker and Invoice in cataract Surgery, stent invoice and sticker in Angioplasty Surgery;
(7) All previous consultation papers indicating history and treatment details for current ailment;
(8) All original diagnostic reports (including imaging and laboratory) along with Medical Practitioner’s prescription and invoice / bill with receipt from diagnostic center;
(9) All original medicine / pharmacy bills along with the Medical Practitioner’s prescription;
(10) MLC / FIR copy – in Accidental cases only;
(11) Copy of death summary and copy of death certificate (in death claims only);
(12) Pre and post-operative imaging reports – in Accidental cases only;
(13) Copy of indoor case papers with nursing sheet detailing medical history of the Insured Person, treatment details and the Insured Person’s progress;
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 xxxx 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 shall be provided with the following necessary information and documentation in respect of all claims at Insured Person’s expense within 30 days of the Insured Person’s discharge from Hospital (in the case of Pre-hospitalization Medical Expenses and Hospitalization Medical Expenses) or within 30 days of the completion of the 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, The Company will be provided these documents by the Network Provider immediately following the Insured Person’s discharge from Hospital:
a. Claim form duly completed and signed by the claimant. Please provide mandatorily following information if applicable
i. Current diagnosis and date of diagnosis;
ii. Previous admission/Surgery if any.
b. Age/Identity proof document of the Insured Person in case of cashless claim (not required if submitted at the time 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 name, IFSC code and account number printed on it of Policyholder / nominee ( in case of death of Policyholder).
d. Original discharge summary.
e. Additional documents required in case of Surgery/Surgical Procedure.
i. Bar code sticker and invoice for implants and prosthesis (if used);
Claims Documentation. To process a claim, the adjustors appointed by JMF’s Insurer will require sufficient documentation from JMF to support the means by which the claimed property valuations were calculated. You must cooperate with JMF in the claim presentation to JMF’s insurer. You must retain, and possibly surrender to us or the authorities, all packaging and items for inspection until such time as the investigation has been completed.
Claims Documentation. Claims must be submitted with accompanying supportive documentation generated as designated by the State. Claims submitted without supportive documentation will be returned to the Contractor and not processed for payment. Failure to perform or execute the policies or provisions made in this Agreement may result in the denial of claim reimbursement.
Claims Documentation. In the interests of prompt settlement of any claim and to avoid prejudicing Your claim under the Policy, You are required to submit all available supporting documentation without delay including:
a) The Original Policy of Insurance.
b) The surveyors report.