Understanding query: Please provide a Self-declaration letter

Query description

Request to provide a self-declaration letter by the patient mentioning the detailed circumstances of the injury with the exact date, time, and place.

An injury is generally defined as harm or damage to the body, often resulting from an external force or accident. In medical terms, an injury can encompass various physical damages. An injury can happen due to an accident, sports / recreational activity, certain environmental factors, etc. While the insurance company covers most injuries that necessitate hospitalization, they often have specific exclusions detailing the type of injuries or events that are not covered. While exclusions can vary among policies, here are some common types of injuries that insurance companies may not cover – Intentional Self-Inflicted Injuries; Injuries as a result of criminal activities; Injuries caused by Participation in Hazardous Activities; Injuries from Substance Abuse etc.

What does this query mean?

The Insurance company would need to establish the cause of the injury to ascertain if it is payable. Patients often provide their doctors with a narrative of the circumstances surrounding their injury, and these details are typically documented in the discharge summary. However, it is incumbent upon the insurance company to make sure that the details provided by the patient to the doctor are accurate. So they seek a self-declaration from the patient describing the cause of the injury. This is essential to determine whether the patient has genuinely described the events leading to the injury or if there is an attempt to obscure the actual reasons behind the incident. Thorough scrutiny by the insurance company is crucial for ensuring an accurate and fair assessment of the claim.

Query resolution

The patient must write a detailed description of how the injury took place. The letter should cover these 5 important aspects:

  • The place where the injury took place
  • Approximate time of the incident
  • What was the patient doing at the time when the injury happened
  • Who were the other people or witnesses present when the incident happened
  • If possible, mention the contact numbers of the witnesses so that the insurance company can verify them

Note: In such claims, you can also expect physical verification from the insurance company. Their field officer may visit and meet the patient and witnesses take photographs of the patient and take their signature on the notes prepared by the field officer. The patient must write a detailed description.

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