Claim Document Checklist for scanned copy submission
DECLARATION BY THE INSURED
DURING SUBMISSION OF SOFT COPIES OF REIMBURSEMENT CLAIM DOCUMENTS
I, , aged
years, enrolled in
Good Health Insurance TPA Limited (TPA)vide GHITL card ID hereby accept the following conditions:
1. I herewith understand that TPA or insurer is not liable to pay by mere submission of my claim documents.
2. The TPA/insurer reserves the right to process the claim as per terms and conditions of the policy.
3. The insurer reserves its right to settle the claim either on soft copies itself or following submission of hard copies.
4. The TPA or insurer reserves its right to recover the settled amount in case of any misrepresentation of facts or fraud is committed by me.
5. I agree to submit the original documents as soon as the lock down is lifted or whenever the TPA /insurer summons for the same even after settlement of the claim.
**** submitted on
from IP ADDRESS