Common use of Claims Documents Clause in Contracts

Claims Documents. a. Basic documents required for all claims: (i) Photo Identity Proof (Any one) - Voter ID, Passport, PAN Card, Driving License, Ration Card, Aadhar, or any other proof accepted by the KYC norms as approved by the Company and which is admissible in court of law (xx) Xxxx completed and signed claim form in original as prescribed by Us. (iii) Copy of FIR/ Panchnama /Police Inquest Report (if conducted) duly attested by the concerned Police Station; (iv) Copy of Medico Legal Certificate(if conducted) duly attested by the concerned Hospital, b. In case of Accidental Death (i) Original Death certificate issued by the office of Registrar of Birth & Deaths; (ii) Death summary issued by a Hospital; (iii) Post Mortem Report (if conducted); (iv) Copies of Medical records, investigation reports, if admitted to hospital (v) Identity proof of Nominee or Original Succession Certificate/Original Legal Heir Certificate or any other proof to the satisfaction of the Company for the purpose of a valid discharge in case nomination is not filed by deceased. (vi) Certificate, if applicable, from the Bank/Financial Institution stating the amortization schedule, the EMI Amounts, Principal Outstanding, etc. Page 8; Kotak Mahindra General Insurance Company Ltd; Kotak Group Accident Care UIN: IRDAI/HLT/KMGI/P-P/V.I/15/16-17; Policy Wording c. Documents required in case of Permanent Total Disablement / Partial Disablement/ Temporary Total Disablement (i) Original treating Medical Practitioner’s certificate describing the disablement; (ii) Original Discharge summary from the Hospital; (iii) Photograph of the Insured Person reflecting the disablement; (iv) Prescriptions and consultation papers of the treatment; Disability certificate issued by civil surgeon or equivalent appointed by the District/State or Government Board. (v) Copies of Medical records, investigation reports, if admitted to hospital (vi) Any other medical, investigation reports, inpatient or consultation treatment papers, as applicable d. Additional documents required in case of Temporary Total Disablement (I) Leave/Absence Certificate from Employer (If Employed)

Claims Documents. a. Basic documents required for all claims: (i) Photo Identity Proof (Any one) - Voter ID, Passport, PAN Card, Driving License, Ration Card, Aadhar, or any other proof accepted by the KYC norms as approved by the Company and which is admissible in court of law (xx) Xxxx completed and signed claim form in original as prescribed by Us. (iii) Copy of FIR/ Panchnama /Police Inquest Report (if conducted) duly attested by the concerned Police Station; (iv) Copy of Medico Legal Certificate(if conducted) duly attested by the concerned Hospital, b. In case of Accidental Death (i) Original Death certificate issued by the office of Registrar of Birth & Deaths; (ii) Death summary issued by a Hospital; (iii) Post Mortem Report (if conducted); (iv) Copies of Medical records, investigation reports, if admitted to hospital (v) Identity proof of Nominee or Original Succession Certificate/Original Legal Heir Certificate or any other proof to the satisfaction of the Company for the purpose of a valid discharge in case nomination is not filed by deceased. (vi) Certificate, if applicable, from the Bank/Financial Institution stating the amortization schedule, the EMI Amounts, Principal Outstanding, etc. Page 8; Kotak Mahindra General Insurance Company Ltd; Kotak Group Accident Care UIN: IRDAI/HLT/KMGI/P-P/V.I/15/16-17; Policy Wording. c. Documents required in case of Permanent Total Disablement / Partial Disablement/ Temporary Total Disablement (i) Original treating Medical Practitioner’s certificate describing the disablement; (ii) Original Discharge summary from the Hospital; (iii) Photograph of the Insured Person reflecting the disablement; (iv) Prescriptions and consultation papers of the treatment; Disability certificate issued by civil surgeon or equivalent appointed by the District/State or Government Board. (v) Copies of Medical records, investigation reports, if admitted to hospital (vi) Any other medical, investigation reports, inpatient or consultation treatment papers, as applicableapplicable Kotak Group Accident Care UIN: IRDAI/HLT/KMGI/P-P/V.I/15/16-17 d. Additional documents required in case of Temporary Total Disablement (I) Leave/Absence Certificate from Employer (If Employed)

Claims Documents. a. Basic (a) The Policyholder or Insured Person (or Nominee or legal heir if the Insured Person is deceased) shall (at his own expense) provide the following documents required for all claims:as specified below and any additional information as necessary under which the Claim is being made with the Company or the Assistance Service Provider immediately and in any event within 30 days of the occurrence of the event. Sr .no Benefit Documents (i1. Hospitalization expenses, Daily Allowance, Option of Waiver of Deducible(if opted)Waiver of Sub-limits(if opted),Option of Co- payment(if opted) Photo Identity Proof (Any oneAdventure Sports Cover(if opted)and Home to Home Cover(if Opted) - Voter ID, Passport, PAN Card, Driving License, Ration Card, Aadhar, or any other proof accepted • Claim Form(filled and signed by the KYC norms Insured) • Release of Medical Information Form(filled and signed by the Insured) • Original pathological and diagnostic reports, discharge summary, indoor case papers (if any) and prescriptions issued by the treating Medical Practitioner or Network Provider • Passport and Visa copy with Entry Stamp of Country of Visit and exit Stamp from India. • Original bills and receipts for ⮚ Charges paid towards Hospital accommodation, nursing facilities, and other medical services rendered ⮚ Fees paid to the Medical Practitioner and for special nursing charges ⮚ Charges incurred towards any and all test and / or examinations rendered in connection with the treatment. ⮚ Charges incurred towards medicines or drugs purchased from a registered pharmacy other than the Network Provider duly supported by the prescriptions of the Medical Practitioner attending to the Insured Person ⮚ Any other document as approved required by the Company and which is admissible in court of law (xx) Xxxx completed and signed claim form in original as prescribed by Usto assess the Claim. (iii) 2. Compassionate Visit • A certificate from the Medical Practitioner recommending the presence in the form of special assistance to be rendered by an additional member during the entire period of hospitalization. The certificate shall also specify the minimum period in which person is admitted in the hospital. • Discharge summary of the Hospital furnishing details including the date of admission and date of discharge. • Stamped boarding pass with invoice used for the travel by the Immediate Family Member. • Copy of FIR/ Panchnama /Police Inquest Report (passport of Immediate Family Member with entry and exit stamp. 3. Return Of Minor Child • A certificate from the Medical Practitioner specifying the minimum period of Hospitalization. • Discharge summary of the Hospital furnishing details including the date of admission and date of discharge. • Stamped Boarding pass used for the return travel of the child to the Country of Residence. • Stamped Boarding pass of the attendant from the Country of Residence to the Place of hospitalization( if conductedattendant is necessary) duly attested by the concerned Police Station; (iv) • Copy of Medico Legal Certificate(if conducted) duly attested by passport of the concerned Hospital,child with entry and exit stamp. b. In case 4. Up-Gradation To Business Class • A certificate from the Medical Practitioner specifying the minimum period of Accidental Death (i) Original Death certificate Hospitalization. • Discharge summary of the Hospital furnishing details including the date of admission and date of discharge. • Copy of the economy class air ticket issued by the office Common Carrier indicating the cost of Registrar the ticket and receipt for the refund of Birth & Deaths;the fare of the Common Carrier and the cancellation charges retained. • Boarding pass and copy of business class ticket confirming the return journey and the cost of ticket. (ii) Death summary 5. Dental Expenses • Original pathological or diagnostic reports and medical prescriptions issued by the treating Medical Practitioner or Hospital; • Original Bills and receipts for: ⮚ Fees paid to the Medical Practitioner and special nursing charges; and ⮚ Charges incurred towards any and all test and / or examinations rendered in connection with the treatment. • Charges incurred towards medicines or drugs purchased from a Hospital;registered pharmacy other than the Hospital duly supported by the prescriptions of the Medical Practitioner attending to the Insured Person; • Any other information or documents related to the treatment taken. (iii6. Personal Accident and Adventure Sports Cover(if opted) Post Mortem Report • Medical reports giving the details of the Accident, nature of the Injury, the extent of disability (if conducted); applicable) and the details of treatment provided. • Death certificate (ivif applicable) Copies of Medical records, investigation reports• Postmortem report, if admitted to hospital (v) Identity proof of Nominee or Original Succession Certificate/Original Legal Heir Certificate or any other proof to the satisfaction of the Company for the purpose of a valid discharge in case nomination is not filed by deceased. (vi) Certificate, if applicable, from the Bank/Financial Institution stating the amortization schedule, the EMI Amounts, Principal Outstanding, etcconducted • Police report. Page 8; Kotak Mahindra General Insurance Company Ltd; Kotak Group Accident Care UIN: IRDAI/HLT/KMGI/P-P/V.I/15/16-17; Policy Wording c. Documents required in case of Permanent Total Disablement / Partial Disablement/ Temporary Total Disablement (i) Original treating • Medical Practitioner’s certificate describing in case of Injury stating the disablement;reasons for and the extent of the Injury (ii) Original Discharge 7. Common Carrier Accidental Death And Disability Additionally ,apart from one’s mentioned under Personal Accident • Valid ticket or certificate from the Common Carrier establishing the Insured Person’s bonafide travel in the affected Common Carrier at the time of the Accident. 8. Repatriation Of • Copy of the death certificate providing details of the place, date, time, and the circumstances and cause of death Mortal Remains • Copy of the postmortem certificate, if conducted • Documentary proof for expenses incurred towards disposal of the mortal remains • In case of transportation of the body of the deceased to the Country of Residence or Place of Residence, the receipt for expenses incurred towards preparation and packing of the mortal remains of the deceased and also for the transportation of the mortal remains of the deceased. 9. Trip Cancellation • If the reason for Cancellation/Interruption is Medical, Insured needs to produce a Medical Certificate and a discharge summary from the Hospital;Medical Practitioner attending the patient. This must confirm the reason and need of Cancellation/Interruption. • Death Certificate(if applicable) • Copy of cancellation proof of the booked tickets indicating the cost of ticket and receipt for the refund of the fare of the Common Carrier towards the cancelled portion of the journey indicating cancellation charges retained by the Common Carrier • Copy of booking as well as cancellation confirmation form the hotel/original scheduled accommodation • In case of cancellation due to loss of passport, FIR copies for loss of passport • Judicial or Law enforcement agency order (if applicable) • Documentary proof of Cancellation of Visa with reason for Cancellation(only for Trip Cancellation due to Cancellation of Visa ) • A declaration from the Insured Person furnishing the circumstances that compelled him to cancel the journey 10. Trip Interruption Additionally ,apart from one’s mentioned under Trip Cancellation • A declaration from the Insured Person furnishing the circumstances that compelled him to interrupt the journey • Details of new bookings for travel with tickets, invoices and receipts 11. Trip Delay • Security-stamped boarding pass for the flight which got delayed • Letter from the Common carrier stating reason and duration of Delay • Passport Copy with Entry and Exit Stamp 12. Loss of Checked-in Baggage • Property irregularity report issued by the appropriate authority. • Voucher of the Common Carrier for the compensation paid for the non- delivery / short delivery of the Checked-In Baggage. • Copies of correspondence exchanged, if any, with the Common Carrier in connection with the non-delivery / short delivery of the Checked-In Baggage. • Proof of ownership and cost for any item which is above INR 5000/- • Final communication from the common carrier/airlines confirming the checked-in baggage to be lost or untraceable. 13. Delay of Checked-in • Property irregularity report issued by the appropriate authority stating the scheduled time of delivery and actual time of delivery of the Checked-In Baggage. Baggage • Voucher of the Common Carrier for the compensation paid for the delay in delivery of the Checked-In Baggage. • Copies of correspondence exchanged, if any, with the Common Carrier in connection with the delay in delivery of the Checked-In Baggage. • Acknowledgement receipt from the Airline mentioning date and time of the delivery of the Baggage. 14. Loss Of Passport And/ Or International Driving License • Copy of the police report • Details of the attempts made to trace the lost item • Original receipt for payment of charges to the authorities for obtaining a new or duplicate passport/IDL • Copy of lost passport or IDL • Copy of new/duplicate passport/IDL 15. Personal Liability • Statement of Claim furnishing particulars of the event leading to the liability such as the court order; • Photocopy of the police report (iiiwherever reported). 16. Hijack-Distress Allowance • Security stamped boarding pass for the flight which got hijacked • Any Government notification confirming the hijack of the said Common Carrier. 17. Missed Flight Connection • Written confirmation from the carrier of the number of hours of delay, and any compensation received towards the delay. • Details of Alternate travel arrangements offered by the carrier, however not accepted with reason of not acceptance. 18. Automatic Trip Extension • Medical certificate with details of the date of admission and date of discharge together with the details of the injury or illness and treatment rendered • Death certificate (if applicable) Photograph • A declaration from the Insured Person furnishing the circumstances that compelled him to extend the Trip. Optional Benefits 1. Life Threatening Condition For PED • Same as per Benefit-1 and any other documents incidental to the Benefits to which this will be applicable 2. Medical Expenses Due To Accident Only • All medical reports and records given by the treating facility. • Receipts for any expenses incurred that are covered in the Policy • FIR report with the Police (if applicable) • Any other documents incidental to the Benefits to which this will be applicable 3. Refund Of Visa Fee (If Visa is Rejected) • Written copy of the rejection reason from the embassy • Passport copy of the Insured Person reflecting • Copy of confirmed ticket Optional Package 1. Loss Of Laptop/Tablet/ Hand Baggage/Perso nal Belongings • FIR copy of the disablement;lost item/(s) • Original bill or bill copy (if original bill not available)for Laptop/Tablet or Proof of purchase of the lost item/(s) • Passport and Visa copy with entry and exit stamp • Letter defining incidence of theft 2. Bounced Booking- Hotel/Commo n Carrier • Written confirmation from the Common Carrier/accommodation provider/ticket provider stating the reason and date for the service cancellation. • Any Receipts of refunds or travel vouchers provided in lieu of the original booking being dishonored. • Bills and payment receipts for alternate tickets/accommodation bookings (ivb) Prescriptions and consultation papers Only in the event that original bills, receipts, prescriptions, reports or other documents have already been given to any other insurance company or to a reimbursement provider the Company will accept properly verified photocopies of such documents attested by such other insurance company/reimbursement provider along with an original certificate of the treatment; Disability certificate issued by civil surgeon or equivalent appointed by the Districtextent of payment received from such insurance company/State or Government Boardreimbursement provider. (vc) Copies The Company shall condone delay on merit for delayed Claims where delay is proved to be for reasons beyond the control of Medical records, investigation reports, if admitted to hospitalthe Policyholder or the Insured Person. (vid) Any other medicalThe Company will condone the delay in making a Claim by the Policyholder or Insured Person on merit, investigation reports, inpatient where delay is proved to be for reasons beyond the control of the Policyholder or consultation treatment papers, as applicable d. Additional documents required in case of Temporary Total Disablement (I) Leave/Absence Certificate from Employer (If Employed)the Insured Person.