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Sr No.
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Type Of Deficiency
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1.
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Neft details (bank details for electronic payment)
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2.
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Original hospital bill & payment receipts
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3.
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Break up of bills
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4.
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Implants & iol sticker / invoices
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5.
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Original investigation reports
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6.
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Details from attending doctor
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7.
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Hospital Bills
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8.
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Settlement letter from other tpa (where main claim is submitted)
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9.
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Kyc documents - address proof for above 1 lac claim amount
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10.
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Age discrepancy - mismatch as per policy and as mentioned in hospital documents
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11.
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Reason for no intimation / delayed intimation
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12.
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Reason for delayed submission
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13.
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Reason for no intimation and/or delayed intimation / submission
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SUGGESTIONS :
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While submitting a claim documents, insured or hospital has to check the claim docket
appropriately to avoid the common deficiencies observed in most of the claims.
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1)
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Claim form must be completely filled
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2)
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Insured / Hospital has to submit all the documents in original
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3)
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Original detailed hospital bills must be along with the all original payments receipts.
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4)
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Detail break up of the expenses charged by the hospital must be available in the
claim documents
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5)
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Whenever, there is use of implants, implants sticker & their invoices are mandatory
in the claim documents
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6)
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kyc documents are compulsory for high value claims (photo identity proof & address
proof of the insured)
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7)
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Insured must always check the age mentioned in the hospital documents, claim form,
insurance policy & kyc documents must be the same.
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8)
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Intimation is compulsory for all claims
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9)
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Submission of claim documents must be within the specified period for the respective
insurance company
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