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Case Ref: CLM-4003-2026
Claim #4003Under Review
Day Care Treatment Examination
Patient: Amit Verma • Policy: POL2003 (Health Insurance (Critical Care))
Claimed Amount
₹32,000
Policy Max Limit: ₹15,00,000
Claim Date
02 Sept 2025
Hospital Facility
Tata Memorial Hospital, Parel, Mumbai
Admission & Discharge
02 Sept 2025 → 02 Sept 2025
Customer Contact
9877665544
Clinical Findings & Invoice Breakdown
Diagnosis & Procedure Description:
Outpatient oncology biological infusion therapy - Cycle 1
Hospital Room Rent:
₹12,000 (Within 1% clause)
OT & Surgeon Fees:
₹38,000 (Verified)
Pharmacy & Consumables:
₹15,000 (Audited)
Adjuster Decision Panel
Execute state transitions modeled in the OOAD Claim State Machine.
Current: Under Review