Deficiency Letter

Without Prejudice

To Date 03/AUG/2021

MOHAN PANDEY , Claim No (CCN) RR-HS21-

, --,B-128 3RD FLOOR FLAT NO.1,, 12534526
DELHI,DELHI,110068,
Contact No.-9711084710,9643161502

Subject : Additional Document Requirement for RR-HS21-12534526 (CCN no)

Reference Details:

Policy No 2805203551307401 HDFC ERGO ID ER2013319753-01E

Employee / Proposal Name MOHAN PANDEY Employee Code NA

Patient Name MOHAN CHAND PANDEY Policy Validity 21/NOV/2021

Hospital Name DR. VIDYASAGAR HEALTH CARE DOA 15/07/2021

CENTER

Ailment / Disease Typhoid fever DOD 23/07/2021

Dear Sir/Madam
We have received claim documents pertaining to above Captioned Claim.

We have scrutinized the documents and from the information gathered during the course, we observe that following documents / Information
necessary for further processing is not provided

1.Investigation reports (Pathological/ Radiological) supporting diagnosis.

2.Copies of ICP (Indoor Case Papers) including the Initial assessment sheet, doctors notes, nursing notes, daily Vital/ TPR chart duly certified
by hospital authority.
3. Need for Prolonged hospitalization.

,
HDFC ERGO
Documents to General Insurance
be sent to Company
below mentioned Ltd.
address:
Stellar IT Park, Tower-1,
5th floor, C-25, Sector-62,
Noida-201301

Please note that the conclusion regarding the eligibility of coverage / admissibility amount can be decided once we have the full set of original
documents

Kindly quote the Claim Control Number (CCN) RR-HS21-12534526 for all future correspondence regarding this claim.

Authorized Signatory

HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 Customer Service Address: D 301, 3rd Floor,
CIN: U66030MH2007PLC177117, Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234 / +91-120 6234 6234 | www.hdfcergo.com