ਆਪਣੀ ਜਾਣਕਾਰੀ ਭਰੋ

HEALTH INSURANCE CLAIM LETTER

Claim for the cost of hospital treatment under a health insurance policy

Date: __________, at __________

__________

To: The __________, Health Claims Department, __________, __________

From: __________, __________ (email __________, telephone __________)

Subject: Claim under policy no. __________ for the treatment of __________

Sir or Madam,

1. 1. The policy. I write about policy no. __________ issued by you, __________, valid from __________ to __________. The insured person is __________, my __________, member id __________. __________

1. 2. The treatment. __________ was admitted to __________, __________, on __________ and discharged on __________. The illness or injury was __________. The treatment was __________. __________

1. 3. How the illness began. __________

1. 4. The claim. __________ The amount I claim is __________, made up as shown in the enclosed bills.

1. 5. Other cover. __________

1. 6. What I ask you to do. Please do all of the following.

(a) Register this claim from today and give me the claim number in writing.

(b) Tell me in one list, at one time, any paper you still need, and the name and number of the officer who is handling the claim.

(c) Decide the claim within the period the rules on policyholders' interests allow, and tell me the date by which you will do so.

(d) If you deduct anything from a bill, give me each deduction and its reason in writing, with the clause of the policy that you rely on.

(e) Pay the amount due by transfer to the account described in paragraph 7.

1. 7. Where to pay. Please pay the amount to the account held by __________ with __________, account ending __________. I will give the full account number on your own form and not in this letter.

1. 9. What I promise. What I have written is true to the best of my knowledge, and I have not kept back any fact about the illness or the policy that you would reasonably want to know. I give you leave to ask the hospital and the treating doctor for the records of this treatment, and I will tell you at once if I learn of any further fact.

1. 10. If the claim is not settled. If you reject the claim, pay only part of it or do not reply, I will appeal to your grievance redressal officer and, if that fails, complain to the Insurance Ombudsman for the area. I am also free to bring a consumer complaint before the District Consumer Disputes Redressal Commission.

Please acknowledge this letter and give me a date-stamped receipt.

ENCLOSURES

__________

LEGAL BASIS

Punjab: A health insurance policy is a contract of insurance, and the insurer must pay a claim that falls within the policy and is not excluded by it; whether a particular illness or period is covered is a question of what the policy says. The insurer decides a claim through its claims office or its third-party administrator and, if the policyholder objects, through its grievance redressal officer, within the periods the Insurance Regulatory and Development Authority's rules on policyholders' interests set, which the letter names without quoting a figure. A policyholder who is not satisfied can complain to the Insurance Ombudsman under the Insurance Ombudsman Rules, 2017, or file a consumer complaint before the District Commission under section 35 of the Consumer Protection Act, 2019, a remedy in addition to other laws under section 100. A dispute that needs a civil court goes to the civil court, with an appeal to the District Judge or the Punjab and Haryana High Court.

Chandigarh: The same law applies to a policyholder in the Union Territory: the contract of insurance, the insurer's grievance redressal officer, the Insurance Ombudsman under the Insurance Ombudsman Rules, 2017, and a consumer complaint before the District Commission serving the Union Territory under section 35 of the Consumer Protection Act, 2019. A dispute for a civil court goes to the civil court at Chandigarh, with an appeal to the District Judge, Chandigarh, or the Punjab and Haryana High Court.

PERSONAL DATA NOTICE

This notice is given under the Digital Personal Data Protection Act, 2023.

The purpose of collecting the personal data in this letter is to identify the policyholder and the patient, record the illness, treatment and bills, and let the insurer decide the claim.

The record will be held by __________ and may be shared with The insurer and its claims, surveyor and grievance officers, the Insurance Ombudsman, any Consumer Commission or court that hears the matter, and the claimant's advocate, the third-party administrator, and the treating hospital and doctor.

If the matter does not proceed, the personal data will be retained for 90 days and then erased. If the matter proceeds, the record will be retained for the transaction or authority matter plus 12 months, except where a statute requires a longer named retention period.

A person named in this document may request correction or erasure where the purpose has ended, withdraw consent for future consent-based processing, or raise a grievance by writing to __________. The record-holder should acknowledge and reply within 30 days.

Data minimisation: this document does not collect a full Aadhaar number, an Aadhaar-card copy, a password or bank credentials.

Personal-data instruction: __________.

SIGNATURE

 
 
______________________________
Signature
Claimant: __________
Place: ____________________
Date: ____________________