Living Benefit (Critical Illness / Medical / Accident) Claims
When occur
Call us immediately, your consultant for Claims Advice & Services
Proof of Insured Peril
Notify the relevant party who can certify the cause, date and time of incident whenever necessary, such as Police, Management office, Common Public Carriers or Airline or Hotel, Doctor….. Collect Relevant Document from the said party.
Proof of
Loss Amount / Covered Benefit / Identity to be Covered as Insuredentity to be Covered as Insured
Book vouchers
Invoices duplicates
Quotation for Repair
Proof of total loss and irrecoverable under Repair
Relevant letter & document from 3rd parties
Invoices / duplicates
Quotation for Repair
Death Certificate
Identity card
Physician’s Comment on death cause in relation to pre-existing condition and
Original medical receipts & discharge bill & supporting report
Diagnostic imaging report
Laboratory tests
Standard Form
Submitting Standard Claims Form which entails information required by insurers
Submission Deadline
Must give notice in writing to insurer within specified period after loss (from 15 to 90 days) Must provide proof of loss to insurer within reasonable period (from 30 to 90 days)
Liability - Providing Proof
The Claimant is liable to provide the required information, evidence or invoices with respect to the claims at the claimant’s expense.
Preventive Measure
The Insured is liable to take positive and possible preventive measures to avoid the chance of loss even though being insured.
Corrective Measure
The Insured is being advised to take corrective measures to avoid the loss severity.
Insurer Investigations if necessary
Independent adjuster to survey losses appointed by insurer
Independent post mortem exam / Private Search for insured’s life-style, back-ground ….
Arbitration, Mediation,Litigation
Ex Gratia Claim Settlement : Insurer makes payment in full or in part out of grace, and not out of legal obligation as per policy contract in exceptional circumstance
Reminders
Disclosure of Material Facts by Utmost Good Faith at the time of Application can assure the default in claims.
NOT to make any admission, offer or promise of payment without insurer’s consent for Liability Claims
NOT to be under-insurance for property insurance, otherwise the insured bears normally the ratable share or certain percentage of loss under AVERAGE CLAUSE, where amount payable by the insurer will be reduced accordingly to the under-insurance.
POLICY EXCESS is normally applied to property and liability insurance, where the insured is responsible for first amount of each and every claim as per Policy Terms. To certain extent, reduction in premium is allowed for higher or voluntary Policy Excess.
