Deficiency Letter

Without Prejudice

To Date 28/JUN/2022

DASHRATHBHAI SHANABHAI Claim No (CCN) RR-HS22-

PARMAR, 13041577
47, GAGANVIHAR SOCIETY,OPP.
NEW WATER TANK,
SHAHWADI,,NAROL, AHMEDABAD,

,,
AHMEDABAD,GUJARAT,382405,
Contact No.-9727317904

Subject : Additional Document Requirement for RR-HS22-13041577 (CCN no)

Reference Details:

Policy No 2805203590180901 HDFC ERGO ID ER2117223778-01E

Employee / Proposal Name DASHRATHBHAI SHANABHAI Employee Code NA

PARMAR

Patient Name DASHRATHBHAI SHANABHAI Policy Validity 17/AUG/2023

PARMAR

Hospital Name YOGI SANJIVANI HOSPITAL DOA 04/06/2022

Ailment / Disease Typhoid fever, unspecified DOD 05/06/2022

HDFC ERGO General Insurance Company Ltd.

Stellar IT Park, Tower-1,
5th floor, C-25, Sector-62,
Noida-201301

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

Documents to be sent to below mentioned address:

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-HS22-13041577 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