Subject: Fwd: Query Claim Number 220202323569 - SAYED HUMERA ABDUL REHMAN
From: Ashish Dabral <[email-masked]>
To: Sayed Humera <[email-masked]>
Date: Tue, 5 Oct 2021 06:21:36 -0700 (MST)

Regards, 
Ashish Dabral 

From: "Swati Shukla, LSM ACCOUNTS" <[email-masked]> 
To: "Ashish Dabral" <[email-masked]> 
Sent: Tuesday, October 5, 2021 6:27:22 PM 
Subject: Fw: Query Claim Number 220202323569 - SAYED HUMERA ABDUL REHMAN 

Best Regards, 

Swati Shukla 

Asst. Manager (Accounts) 

8882991655 

From: [email-masked] <[email-masked]> 
Sent: Tuesday, October 5, 2021 6:26 PM 
To: Swati Shukla (LSM ACCOUNTS) <[email-masked]> 
Subject: Query Claim Number 220202323569 - SAYED HUMERA ABDUL REHMAN 

		
	ADDITIONAL INFORMATION REQUEST FORM 

	Ref : CPU100 
	Date: 05-OCT-21 
	To, 
	SWATI SHUKLA 		
	LIVE SALESMAN 
FIRST FLOOR, A-72, SEC-2, NOIDA, Gautam Buddha Nagar,Uttar Pradesh, 201301 
NOIDA,Uttar Pradesh-201301 		
	Dear Sir/Madam, 
		Claim Number 	220202323569 	
		Claim of 	SAYED HUMERA ABDUL REHMAN 	
		UHID 	IL19316637100 	
		Policy Number 	4016/X/221916670/00/000 	
		Policy Name 	LIVESALESMAN 	
		Coverage Period 	31-JUL-21 to 19-APR-22 	
		Date of Admission 	16-AUG-21 	
		Date of Discharge 	20-AUG-21 	
		Diagnosis 	Cholelithiasis 	
		Hospital Name 	HAH Centenary Hospital 	
		AL Number 		
	
On behalf of ICICI Lombard General Insurance Co. Ltd, we thank you for preferring ICICI Lombard as your health insurance partner.With reference to your claim intimated in our office we request you to send the following documents for further processing of your claim. 

> 

Sr No Reason Description 
	1 	Document Deficiency 	

    1. Kindly provide the date wise break up for the charges incurred in the final bill (investigations,procedure,consultation etc.) for further processing of the claim. 

	Note: C-KYC form can be download from the following link 
	[ https://lsmindia.com/www.icicilombard.com/downloads | http://www.icicilombard.com/downloads ] -> Health Insurance -> Claims -> Central KYC form 
	“ALL ABOVE MENTIONED DOCUMENTS TO BE SUBMITTED IN ORIGINAL” 

	Please submit the documents to us within 7 days from the date of receipt of this letter at the below mentioned address to ensure speedy service. Please note that the conclusion regarding the eligibility of coverage /admissible amount can only be arrived on submission of the above mentioned documents. In case of any further clarification, please feel free to write to us at the below mentioned address. Please quote our claim number as mentioned above in all your claim correspondences. We look forward to your co-operation in helping us serve you better. 

	

Associate Vice President- Health Claims 

For ICICI Lombard General Insurance Company Ltd 

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