PARAMOUNT HEALTH SERVICES & INSURANCE TPA PRIVATE LIMITED

(IRDA License No.006) Validity: From 21-03-2023 to 20-03-2026

[formerly known as PARAMOUNT HEALTH SERVICES(TPA)PVT.LTD]

H. No.6-3-352, 4th Floor, Banjara Hills, Osman Plaza,,Banjara Hills, Road No. 1, Hyderabad, Telangana - 500082,Hyderabad-500082 Tel-
(040)-66366721/66758271,Banjara Hills ,Fax-(040)-55366271,E-mail -contact.phs@paramounttpa.com

Deficiency Letter
Without Prejudice

To, Date : 24/02/2024

SONY INDIA (P) LTD.,
C/O VENKATA SUBRAMANIAN Y,

Email id:
venkatasubramanian.y@sony.com
Mobile No. : 8889910202

Policy & Member Details Claim Details

Insurance Company : Cholamandalam General Insurance Co Ltd CCN No. : 6580236 Ext: Partial :

Policy No. : 2825/00000069/000/20 Name of Patient :YEGNESWARAN

Policy Validity : 22/11/2023 to 21/11/2024 Date of Admission :29/12/2023

Employee Name : VENKATA SUBRAMANIAN Y Date of Discharge :03/01/2024

PHS ID.No. : 2696355 Employee No. : 2191

Provider Name:C.J HOSPTIAL (AVUDAYANOOR)
Insurance Claim No:

Ailment : Fracture Shaft Of Left Femur

Dear Sir/Madam,
We are in receipt of the documents forwarded by you pertaining to the captioned claim. On scrutinizing the documents,it is observed that the following
documents / information are required to process your claim:

Sr.No Deficiency Type Mandatory Status

ACCIDENT / BURNS / POISIONING /FALL / RTA: Duly signed & stamped certificate from first attending doctor/Hospital
1 authority with following details: a) Incident details of accident/injury-when (date),where (place),how (details & what caused it) Yes Pending
b) Record of any signs of substance abuse (alcohol/ drugs) at the time of accident

2 DELAY: Letter from insured, stating reason for delayed intimation. Yes Pending

INDOOR CASE PAPERS: Complete xerox set of indoor case papers with admission/emergency notes, daily doctor notes,OT
3 Yes Pending
notes(for surgical cases) nursing chart including TPRBP chart and drug chart.

4 POSITIVE INVESTIGATION: report / investigation / films / plates to establish the ailment/diagnosis. Yes Pending

5 INVESTIGATION REPORTS Particular Bill No Bill Date Amount

a Investigation reports against the submitted bills 1 Yes Pending

You are requested to submit the original documents as mentioned above within 14 days from the receipt of this letter,so that we can proceed further and
process the claim.Please note that the conclusion regarding the eligibility of coverage/admissibility amount can only be decided once we have a full set of
original documents. Your co-operation in this regard shall be highly appreciated.
Kindly quote the CCN for all future correspondence regarding this claim.

Thanking You,

Medical Officer
For Paramount Health Services & Insurance TPA Private Limited

Please Provide your Email Id. & Contact No. for future correspondence.

For complete guidance on your current claim status,please log on to our website www.paramounttpa.com
 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PRIVATE LIMITED
(IRDA License No.006) Validity: From 21-03-2023 to 20-03-2026
[formerly known as PARAMOUNT HEALTH SERVICES(TPA)PVT.LTD]

H. No.6-3-352, 4th Floor, Banjara Hills, Osman Plaza,,Banjara Hills, Road No. 1, Hyderabad, Telangana - 500082,Hyderabad-500082 Tel-
(040)-66366721/66758271,Banjara Hills ,Fax-(040)-55366271,E-mail -contact.phs@paramounttpa.com

CLAIM ACKNOWLEDGMENT SHEET

Name of Insurer : Cholamandalam General Insurance Co Ltd CCN NO : 6580236

Insured Name : VENKATA SUBRAMANIAN Y Policy No : 2825/00000069/000/20
PHS ID : 2696355 Patient Name : YEGNESWARAN
Mobile No : 8889910202 Employee No : 2191

Name of Corporate :

Type of Claim (To be ticked) : Main Hospitalisation / Pre-Post Hospitalisation / OPD Claim
Total no of documents received 27
Sr No. Category Document received Yes/no No of documents
1 claim Form YES 5
2 KYC DOCUMENTS NO 0
3 NEFT DOCUMENTS NO 0
4 DELAY INTIMATION / SUBMISSION DOCUMENTS NO 0
5 DISCHARGE CARD /DEATH SUMMARY /TRANSFER SUMMARY YES 3
6 Indoor Case Paper NO 0
7 FINAL HOSPITAL BILL YES 2
8 FINAL HOSPITAL CASH RECEIPT YES 1
9 CONSULTATION CASH RECEIPT NO 0
10 INVESTIGATION CASH RECEIPT YES 3
11 INVESTIGATION REPORT NO 0
12 MEDICINE CASH RECEIPT YES 10
13 MEDICINE PRISCRIPTION YES 2
14 IMPLANT STICKER NO 0
15 64 VB DOCUMENTS NO 0
16 POLICY COPY NO 0
17 PAN CARD NO 0
18 AADHAR CARD NO 0
19 CKYC NO 0
20 Other YES 1