Verification of documents

What are the documents required to process a claim?

a)      Documents which prove the existence of a disease

b)      Treatment given at the hospital

c)      Investigation reports

d)     Duration if stay at the hospital

e)      if any payment has been made to the hospital by the insured

f)       if the discharge summary advises for further treatment.

g)      if there have been implants, the invoices and payments for the same.

The insurer may ask for other documents. Most of the documents will be required in original.

If there are discrepancies in your documents, even your genuine claim may be dishonored by the insurer as we can see in the following case:

Bhagat Singh Mandoloi vs. Manipal Cigna

Award no. IO/BHP/A/HI/0060/2019-20       

Eventually this case was decided in the favour of the insured but the point is, the insurer chose to deny the claim based on discrepancies in the documents. Actually, the decision of the Insurance Ombudsman could have easily gone against the insured.