We shall settle claims, including its rejection, within 5 (five) working days of the receipt of the last ‘necessary’ document but not later than 30 days.
You should submit the post-hospitalization claim documents at your own expense within 15 days of completion of post-hospitalization treatment or period, whichever is earlier. We shall receive pre and post- hospitalization claim documents either along with the inpatient hospitalization papers or separately and process the same based on merit of the claim derived on the basis of documents received.
The sum insured opted under the plan shall be reduced by the amount payable / paid under the benefit(s) and the balance shall be available as the sum insured for the unexpired policy period. We are not obliged to make payment for any claim or that part of any claim that could have been avoided or reduced you/ insured person could reasonably have minimized the costs incurred, or that is brought about or contributed to by you/insured person failing to follow the directions, advice or guidance provided by a medical practitioner. If you/ insured person suffers a relapse within 45 days of the date of discharge from the hospital for which a claim has been made, then such relapse shall be deemed to be part of the same claim and all the limits for “instance of same illness” under this policy shall be applied as if they were under a single claim.
Where a rejection is communicated by us, you may if so desired within 15 days represent to us for reconsideration of the decision.
Completed claim forms and documents must be furnished to us within the stipulated timelines. Failure to furnish such evidence within the time required shall not invalidate nor reduce any claim if you can satisfy us that it was not reasonably possible for you to submit / give proof within such time. The due intimation, submission of documents and compliance with requirements by you as mentioned above shall be essential failing which we shall not be bound to entertain a claim.
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