Home / Tools / Which documents decide your claim Which documents decide your claim A claim dispute is decided on documents. Which ones matter depends on what went wrong, so choose the situation closest to yours and work down the list.
Each item says what it is for. Tick them off as you find them — the ticks stay in this browser and are never sent anywhere.
What happened to your claim? My claim was rejected My claim is taking too long I was paid less than expected Cashless was refused at the hospital
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Policy wording The contract itself. Every argument about what is covered is settled here, not in the letter. Policy schedule Your dates, sum insured, members and endorsements — the numbers that apply to you specifically. The insurer's decision letter The reason you are answering, and the clause it relies on. The written refusal of pre-authorisation Ask the hospital's insurance desk before you leave. It is far harder to obtain afterwards. The computation or settlement sheet It lists each deduction against the clause it came from, which is what a short payment has to be argued from. Discharge summary The clinical record, including when a condition was first known. It does more work than anything else in a dispute. Final itemised bill and payment receipts What was charged, and what you actually paid. Investigation reports and prescriptions What was done and why — the evidence behind a medical-necessity argument. Claim form and its acknowledgement What you told the insurer, and the date they accepted it. Earlier policy documents Continuous cover from an earlier year can move a waiting period years earlier than the current policy's date. Proposal form Relevant whenever non-disclosure is alleged: compare the question asked with the answer given. Every message to and from the insurer, with dates A delay is proved by a chronology, not by frustration. Keep proof of sending, not just of writing. Call notes and reference numbers Date, who you spoke to, what they said. Follow a call with a short email repeating it, so the record exists in writing. Your ticks are saved in this browser only. Nothing here is sent to ClaimAssure, and clearing your browser data clears them.
What this cannot do. A general list, not a list built from your claim. The insurer's stated reason decides what actually matters, and reading that reason against your own policy is what narrows it.
Not sure what you are still missing? Upload what you already have. ClaimAssure reads it, works out which documents your case still needs for the reason the insurer gave, and asks for them one at a time.
Check what's missing ClaimAssure is an independent private platform. It is not an insurer, IRDAI, Bima Bharosa or the Insurance Ombudsman, it never files anything on your behalf, and it cannot promise any outcome. What it does is read your documents and show you what they say.
Read the guides for the longer explanations behind all of this.