Personal Accident Claim Requirements

  • Accomplished Claim Form
  • Hospital Statement of Account with Room & Board Charges
  • Hospital Official Receipt of Payment
  • Hospital Itemized Receipt and/or Charge Slips
  • Physician's Fee Official Receipt
  • Doctor's Prescription and Drug Store Invoice of Medicines Purchased
  • Affidavit of Accident/Police Report
  • Medical Certificate

 

Other documents which may be requested:

  • Medical History
  • Admitting History
  • Discharge Summary
  • Operative Record
  • Medical Chart
  • Physical Examination Result
  • Hospital Clinical Abstract/Summary
  • Official Receipt, Surgeon's & Anesthesiologist's Fee
  • Hospital Certification of confinement, specifying date of admission and date of discharge

 

Death Claim Requirements:

  • Affidavit of Accident/Police Report
  • Medical Certificate/Death Certificate
  • Medical Expense Incurred
  • Post Mortem Report
  • Proof of relationship with insured
  • Birth Certificate