Terms of Service

Introduction

These Terms of Service ("Terms", "Terms of Service", or "Agreement") constitute a legally binding agreement between you and Indiem (hereinafter referred to as "the Company", "we", "us", or "our"), a company registered under the Companies Act, 2013, having its registered office at Office No – 101, First Floor, Plot No. A-61, Sector-16, Noida, UP-201301.

These Terms govern your access to and use of:

• Our website www.indiem.tech ("Website")
• Our mobile applications (if applicable)
• All related services, products, and content (collectively referred to as "Services")

By accessing or using our Services, you agree to be bound by these Terms of Service and our Privacy Policy, which is incorporated herein by reference. If you do not agree to these Terms, you must not access or use our Services.

1. Definitions

"User" or "You" means:

• Hospitals that access or use our Services for health insurance claim management
• Patients who share their information with us or avail our claim assistance services
• Any individual or entity that visits or uses our Website

"Services" means all services provided by the Company, including but not limited to:

For Hospitals:

• Health Claim Cashless processing
• Genuine Cashless Rejection Claims management
• Pre-authorization approval assistance
• Claim desk management
• Hospital MIS and analytics

For Patients:

• Health Claim Reimbursement processing
• Rejected Claims Recovery
• Claims Delay Resolution
• Claim Short-Settlement recovery
• Documentation assistance
• Insurance company liaison

"Applicable Law" means any statute, law, regulation, ordinance, rule, judgment, order, decree, clearance, approval, directive, guideline, policy, requirement, or other governmental restriction having jurisdiction over the subject matter of these Terms.

"Personal Information" and "SPDI" have the meanings assigned to them in our Privacy Policy.

"Third Party" includes insurance companies, Third Party Administrators (TPAs), hospitals, diagnostic centers, and other service providers.

2. Acceptance of Terms

2.1 Agreement to Terms

By accessing or using our Services, you acknowledge that:

1. You have read, understood, and agree to be bound by these Terms
2. You have read and agree to our Privacy Policy
3. You are at least 18 years of age and legally capable of entering into binding contracts
4. If you are accessing on behalf of an organization, you have the authority to bind that organization to these Terms

2.2 Modifications to Terms

We reserve the right to modify these Terms at any time for legitimate business purposes, including compliance with legal and regulatory frameworks. When we make changes:

• We will post the modified Terms on our Website
• We will update the "Effective Date" at the top
• We may notify you via email or Website notification for material changes

Your continued use of Services after changes constitutes acceptance of the modified Terms.

It is your responsibility to review these Terms periodically. If you do not agree to the modified Terms, you must discontinue use of our Services.

3. Eligibility and User Registration

3.1 Eligibility Requirements

For Hospitals:

• Must be a legally registered hospital or healthcare facility in India
• Must have valid registration with appropriate medical and statutory authorities
• Must have authorized representatives with power to bind the hospital

For Patients:

• Must be 18 years of age or older
• Must have a valid health insurance policy
• Must provide accurate and complete information
• Minors may use Services only under parent/legal guardian supervision

3.2 Account Registration

To access certain Services, you must create an account by providing:

• Complete and accurate registration information
• Valid contact details (email and phone number)
• Identity verification documents
• Any other information reasonably requested by us

Account Responsibilities:

You agree to:

• Maintain the confidentiality of your account credentials
• Be solely responsible for all activities under your account
• Notify us immediately of any unauthorized use or security breach
• Not create multiple accounts or fake accounts
• Not transfer or share your account with others
• Keep your account information current and accurate

Account Termination:

We reserve the right to suspend, deactivate, or terminate your account if:

• You breach these Terms
• You provide false or misleading information
• Your account is inactive for an extended period
• Required by law or regulatory authority
• We discontinue Services to all users

4. Services Description

4.1 Hospital Services

Cashless Claim Processing:

• Pre-authorization request submission
• Document verification and compilation
• Liaison with insurance companies and TPAs
• Query resolution and follow-up
• Approval facilitation

Cashless Rejection Management:

• Analysis of rejection reasons
• Documentation review and correction
• Appeal preparation and submission
• Follow-up with insurers and TPAs

Pre-authorization Approval:

• Real-time pre-auth request processing
• Document management and submission
• Multi-level follow-up
• Approval tracking and updates

4.2 Patient Services

Reimbursement Claim Processing:

• Document collection and verification
• Claim form preparation and submission
• Follow-up with insurance companies
• Status tracking and updates
• Payment facilitation

Rejected Claim Recovery:

• Rejection reason analysis
• Document rectification
• Appeal drafting and submission
• Negotiation with insurance companies
• Claim resubmission

Claim Delay Resolution:

• Delay reason identification
• Multi-level escalation
• Regular follow-up with insurers and TPAs
• Resolution tracking

Short-Settlement Recovery:

• Settlement analysis
• Discrepancy identification
• Additional claim submission
• Negotiation for full settlement

4.3 Service Limitations

We do NOT:

• Sell insurance policies
• Act as an insurance company or TPA
• Guarantee claim approval or specific claim amounts
• Provide medical advice or treatment
• Make payment decisions on behalf of insurance companies
• Have authority to approve or reject claims

5. User Obligations and Representations

5.1 Accuracy of Information

You represent and warrant that:

• All information provided by you is true, accurate, current, and complete
• You have the right to provide such information
• You will promptly update any changes to your information
• You have not misrepresented your identity or information

5.2 Hospital Obligations

Hospitals agree to:

• Provide accurate patient information and medical records
• Comply with medical ethics and patient confidentiality requirements
• Cooperate in documentation and verification processes
• Respond promptly to our requests for information
• Maintain proper billing and documentation practices
• Ensure authorized personnel access the Services

5.3 Patient Obligations

Patients agree to:

• Provide complete and accurate medical and insurance information
• Submit required documents in timely manner
• Cooperate in the claim processing workflow
• Respond to queries and requests for clarification
• Inform us of any changes in insurance coverage or contact details
• Not submit fraudulent or inflated claims

5.4 Prohibited Conduct

You shall NOT:

• Use Services for any unlawful purpose
• Submit false, fraudulent, or misleading information
• Violate any applicable laws, regulations, or third-party rights
• Attempt to gain unauthorized access to our systems
• Interfere with or disrupt our Services
• Use automated systems (bots, scrapers) without authorization
• Impersonate another person or entity
• Upload viruses, malware, or harmful code
• Engage in any activity that harms our reputation or business
• Use Services to compete with us or develop competing services
• Share confidential information obtained through Services

6. Fees and Payment

6.1 Service Fees

Hospital Services: [Specify fee structure - e.g., monthly subscription, per-claim fee, percentage-based]

Patient Services:

• Registration fee: ₹[Amount] (one-time, upon case acceptance)
• Success fee: [X]% + GST of claim amount recovered (payable only upon successful claim resolution)

6.2 Payment Terms

• All fees are in Indian Rupees (INR)
• Fees are non-refundable except as required by law
• Payment must be made through authorized payment methods
• You authorize us to charge the payment method provided
• You are responsible for any applicable taxes
• Late payments may result in service suspension
• We reserve the right to modify fees with reasonable notice

6.3 No Upfront Guarantee

We do not guarantee:

• Claim approval or specific claim amounts
• Specific timelines for claim resolution
• Any particular outcome or success rate

Payment of fees does not guarantee any specific result but compensates us for our professional services and efforts.

7. Intellectual Property Rights

7.1 Company Intellectual Property

All content on our Website and Services, including but not limited to:

• Text, graphics, logos, images, audio, video
• Software, source code, algorithms
• Designs, layout, look and feel
• Trademarks, service marks, trade names
• Databases and compilations

are owned by or licensed to the Company and protected by Indian and international intellectual property laws, including copyright, trademark, patent, and trade secret laws.

7.2 Limited License

We grant you a limited, non-exclusive, non-transferable, revocable license to:

• Access and use our Services for their intended purpose
• View and download Website content for personal, non-commercial use

You may NOT:

• Copy, modify, distribute, or create derivative works
• Reverse engineer or decompile our software
• Remove or modify any copyright or proprietary notices
• Use our intellectual property for commercial purposes without written consent
• Frame or mirror any portion of our Website

7.3 User Content

By submitting content (documents, information, feedback) to us, you grant us a worldwide, non-exclusive, royalty-free, perpetual license to use, reproduce, modify, and display such content solely for providing our Services. You represent that you have all necessary rights to grant this license.

8. Confidentiality

8.1 Confidential Information

Both parties agree to maintain the confidentiality of all confidential information received, including:

• Personal Information and SPDI
• Medical records and health information
• Insurance policy details
• Business information and trade secrets
• Financial information

8.2 Use of Confidential Information

Confidential information may only be used for the purposes of providing or receiving Services and shall not be disclosed to third parties except:

• As authorized by you
• As required by law
• To service providers under confidentiality obligations
• To insurance companies and TPAs for claim processing

8.3 Security Measures

We implement reasonable security measures to protect confidential information (see Privacy Policy for details). You must also take reasonable precautions to protect your account credentials and information.

9. Disclaimer of Warranties

9.1 "AS IS" and "AS AVAILABLE" Basis

OUR SERVICES ARE PROVIDED ON AN "AS IS" AND "AS AVAILABLE" BASIS WITHOUT WARRANTIES OF ANY KIND, EITHER EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO:

• Warranties of merchantability
• Fitness for a particular purpose
• Non-infringement
• Accuracy, reliability, or completeness of information
• Uninterrupted or error-free service
• Security or freedom from viruses

9.2 No Medical or Legal Advice

We do not provide medical, legal, or financial advice. Our Services are administrative in nature and do not replace professional consultation with doctors, lawyers, or financial advisors.

9.3 Third-Party Services

We are not responsible for:

• Decisions made by insurance companies or TPAs
• Quality of medical care provided by hospitals
• Accuracy of information provided by third parties
• Availability or performance of third-party services
• Actions or omissions of hospitals, insurers, or TPAs

9.4 No Guarantee of Outcomes

We cannot and do not guarantee:

• Approval of insurance claims
• Specific claim amounts or settlements
• Timelines for claim processing
• Success in recovering rejected claims
• Any particular outcome or result

10. Limitation of Liability

10.1 Limitation of Damages

TO THE MAXIMUM EXTENT PERMITTED BY LAW, THE COMPANY SHALL NOT BE LIABLE FOR:

Indirect, Incidental, Special, Consequential, or Punitive Damages, including but not limited to:

• Loss of profits or revenue
• Loss of data or information
• Business interruption
• Loss of opportunity
• Reputational harm

arising from or related to:

• Your use or inability to use our Services
• Any claim processing delays or denials
• Unauthorized access to your account
• Errors, omissions, or inaccuracies in our Services
• Actions of third parties (insurers, hospitals, TPAs)

10.2 Cap on Liability

Our total liability for any claims arising from or related to these Terms or our Services shall not exceed:

• For Hospitals: The amount of fees paid by you in the 12 months preceding the claim
• For Patients: The amount of fees paid by you for the specific case

10.3 Specific Disclaimers

The Company shall NOT be liable for:

• Claim rejections or delays by insurance companies or TPAs
• Inaccurate information provided by you or third parties
• Medical treatment decisions or outcomes
• Hospital billing disputes
• Payment processing delays by financial institutions
• Force majeure events (see Section 11)

11. Force Majeure

We shall not be liable for any failure or delay in performing our obligations due to circumstances beyond our reasonable control, including but not limited to:

• Natural disasters (earthquakes, floods, pandemics)
• War, terrorism, civil unrest
• Government actions or regulations
• Labor disputes or strikes
• Internet or telecommunications failures
• Power outages or infrastructure failures
• Acts of God

12. Indemnification

12.1 Your Indemnification

You agree to indemnify, defend, and hold harmless the Company, its affiliates, officers, directors, employees, agents, and representatives from and against any and all claims, liabilities, damages, losses, costs, and expenses (including reasonable attorneys' fees) arising from or related to:

• Your breach of these Terms
• Your violation of any law or third-party rights
• Your use or misuse of our Services
• Information you provide to us
• Your negligence or willful misconduct
• Claims by insurance companies, hospitals, or patients related to your actions

12.2 Defense of Claims

We reserve the right, at our own expense, to assume the exclusive defense and control of any matter subject to indemnification by you. You agree to cooperate fully with our defense of such claims.

13. Termination

13.1 Termination by You

You may terminate your account and stop using our Services at any time by:

• Following the account deactivation process on our Website
• Sending written notice to [shashank.agnihotri@indiem.tech]

13.2 Termination by Us

We may immediately terminate or suspend your access to Services, without notice, if:

• You breach these Terms or our Privacy Policy
• You engage in fraudulent or illegal activities
• You provide false or misleading information
• Your account remains inactive for [X] months
• Required by law or regulatory authority
• We discontinue Services (with reasonable notice)

13.3 Effect of Termination

Upon termination:

• Your right to access and use Services immediately ceases
• You must pay all outstanding fees
• We may delete your account and associated data (subject to legal retention requirements)
• Provisions that should survive termination (including confidentiality, indemnification, limitation of liability) shall remain in effect
• No refunds will be provided except as required by law

14. Dispute Resolution

14.1 Grievance Redressal

Before initiating any legal proceedings, you agree to first attempt to resolve disputes through our internal grievance mechanism:

Step 1: Send a written complaint to our Grievance Officer:

• Name: Shashank Agnihotri
• Email: shashank.agnihotri@indiem.tech
• Address: Office No – 101, First Floor, Plot No. A-61, Sector-16, Noida, UP-201301

Step 2: We will acknowledge your complaint within 10 working days

Step 3: We will attempt to resolve the dispute within 30 days

14.2 Negotiation

If the grievance mechanism does not resolve the dispute, both parties agree to negotiate in good faith for 30 days before initiating formal proceedings.

14.3 Governing Law

These Terms shall be governed by and construed in accordance with the laws of India, without regard to conflict of law principles.

14.4 Jurisdiction

Any disputes arising from or relating to these Terms or our Services shall be subject to the exclusive jurisdiction of the courts in Noida, India.

14.5 Class Action Waiver

You agree that any dispute resolution proceedings will be conducted only on an individual basis and not in a class, consolidated, or representative action.

15. General Provisions

15.1 Entire Agreement

These Terms, together with our Privacy Policy and any other policies referenced herein, constitute the entire agreement between you and the Company regarding our Services and supersede all prior agreements and understandings.

15.2 Severability

If any provision of these Terms is found to be invalid, illegal, or unenforceable, the remaining provisions shall continue in full force and effect. The invalid provision shall be modified to the minimum extent necessary to make it valid and enforceable.

15.3 Waiver

Our failure to enforce any right or provision of these Terms shall not constitute a waiver of such right or provision. Any waiver must be in writing and signed by an authorized representative of the Company.

15.4 Assignment

You may not assign or transfer these Terms or your rights hereunder without our prior written consent. We may assign these Terms or our rights to any affiliate or successor entity without restriction.

15.5 No Third-Party Beneficiaries

These Terms do not create any third-party beneficiary rights except as expressly stated herein.

15.6 Notices

All notices under these Terms must be in writing and delivered to:

To Company:

• Indiem
• Office No – 101, First Floor, Plot No. A-61, Sector-16, Noida, UP-201301
• Email: shashank.agnihotri@indiem.tech

To You:

At the email address or physical address provided in your account

Notices are deemed received:

• Immediately if delivered by email (during business hours)
• 3 business days if sent by courier or registered post

15.7 Relationship of Parties

Nothing in these Terms creates a partnership, joint venture, agency, franchise, employment, or fiduciary relationship between you and the Company. You have no authority to bind the Company in any manner.

15.8 Language

These Terms are executed in English. Any translation is provided for convenience only. In case of conflict, the English version shall prevail.

15.9 Electronic Communications

By using our Services, you consent to receive electronic communications from us. You agree that all agreements, notices, disclosures, and other communications provided electronically satisfy any legal requirement that such communications be in writing.

16. Compliance with Laws

16.1 Regulatory Compliance

We operate in compliance with:

• Information Technology Act, 2000
• Insurance Regulatory and Development Authority of India (IRDAI) regulations
• Insurance Act, 1938
• Data protection and privacy laws
• Consumer protection laws
• Healthcare and medical privacy regulations

16.2 Anti-Fraud Provisions

Both parties agree to:

• Not engage in any fraudulent activities
• Report suspected fraud to appropriate authorities
• Cooperate with investigations
• Maintain accurate records and documentation

16.3 Your Compliance

You agree to comply with all applicable laws and regulations in your jurisdiction when using our Services, including but not limited to:

• Insurance regulations
• Tax laws
• Consumer protection laws
• Data protection and privacy laws

17. Important Disclaimers

17.1 Not an Insurance Company or TPA

WE ARE NOT:

• An insurance company
• A Third Party Administrator (TPA)
• Licensed to sell insurance policies
• Authorized to approve or reject insurance claims

WE ARE:

• A technology-enabled service provider
• Facilitators of insurance claim processing
• Administrative support for hospitals and patients

17.2 No Guarantee of Results

We provide best-effort services but cannot guarantee:

• Approval of any insurance claim
• Specific claim amount settlements
• Timelines for claim processing by insurers
• Success in recovering rejected claims
• Any particular outcome or result

17.3 Insurance Company Decisions

Final decisions on claim approval, rejection, amount payable, and settlement timing are made solely by insurance companies and TPAs. We have no control over or responsibility for such decisions.

18. Contact Information

For questions, concerns, or support regarding these Terms or our Services:

• Indiem
• Registered Office: Office No – 101, First Floor, Plot No. A-61, Sector-16, Noida, UP-201301
• Email: contact@indiem.tech
• Phone: +91 9675124370
• Website: www.indiem.tech

Grievance Officer: Shashank Agnihotri, shashank.agnihotri@indiem.tech