We strive to make your claim settlement a smooth experience. To accomplish this, we are working to ensure a convenient and efficient process. One component of a seamless claim process is assessing your claim thoroughly without any hassles. For this, we require all the necessary documentation.
To complete the documentation requirements of any accidental, trauma or suicidal claims, a copy of the MLC and/or the FIR is required.
Understanding MLC and FIR:
A Medico-Legal Certificate (MLC) is a medical record required by law when someone is hospitalised due to incidents like suspicious suicide attempts, trauma, assaults, or accidents. Along with medical care, these cases often need the involvement of an external law enforcement agency.
A First Investigation Report (FIR) is a local police documented report detailing every preliminary information of a serious offence, before further investigation. It contains basic details of the incident like the time, location, and nature of the incident, apart from any information on the victim, witnesses, and suspects. Any investigations precede the basis of the information documented in the FIR.
The Significance of a MLC and FIR in Healthcare Claims:
The claim process requires these records to confirm that the legal and medical rules are followed, especially for accidents, injuries, or crimes. These records help evaluate injuries, the treatment provided, and the costs incurred. They give written proof of what happened, helping insurers verify if the incident transpired as claimed. With the information available in the MLC and FIR, the team can better scrutinise if the claim is payable by assessing the injuries sustained. Please note that all self-harm claims are not admissible for coverage.
What a MLC looks like:
What an FIR looks like:
Addressing Challenges:
You are advised to contact the concerned authority to procure a copy of the MLC and/or FIR. Claims get automatically rejected if the MLC and/or FIR copy is not provided within the designated timeframe.
Important Note – If MLC is charged a minimum fee by the hospital in the final bill invoice, submitting the certificate becomes non-negotiable.
Conclusion:
The MLC and FIR provide comprehensive information on the injury from legal and medical perspectives. MLC focuses on information on the sustained injuries while the FIR details the overall information of the incident. These records are necessary to confirm the claim payability. For a fair and speedy claim process, the MLC and/or FIR proof must be submitted without fail.
