Claims

In the unfortunate event that you are involved in an accident, here are few reminders that will save you from future inconveniences:

1. Report the accident immediately to our Motor Car Claims Department or to your Account Manager so that we can properly advise and assist you in the matter.
2. In case the accident involves a third party, do not immediately admit liability or make any payment or commitment without the approval of the insurance company.
3. Do not authorize any repair on your vehicle unless the insurance company has given its approval.
4. In case of flood, do not try to re-start a car that has been soaked in water.

Please note that failure to follow 2 & 3 may prejudice your policy rights and make it difficult or give your insurer the reason to deny your claim. Listed below are the other possible reasons for motor car claims to be denied:

1. Late filing (as stated in the policy, the insured shall, as soon as possible, give notice thereof to the Company the full particulars)
2. Discrepancy of details (particularly on registered owner, serial number, motor number and other particulars stated in the policy)
3. Undeclared Accessories (e.g. Bull bars, Tint, Mags & Stereo not standard, roof racks and others)
4. Unauthorized repair
5. Unauthorized driver; Restriction Code; expired Driver’s License; Drunk driving
6. Unpaid premiums
7. Accepting settlement with the person at fault (compromise settlement/final settlement) which is not substantial for the repair of the damaged vehicle

The early settlement of your motor car claim is very much dependent on the completeness of the documents submitted. For your reference and guidance, the following are the required claim documents for the various kinds of motor car claims.

Own Damage Claim

1. Police report or a notarized affidavit of the driver stating the facts of the accident
2. Photocopy of the Certificate of Registration with the official receipt
3. Photocopy of the driver´s license with the official receipt
4. Pictures of the damaged portion(s) of the insured unit, with at least one showing the plate number
5. Repair estimate
6. Stencil of motor and chassis numbers.

Third Party Liability - Property Damage Claim

1. Police report or a notarized affidavit of the driver stating the facts of the accident
2. Photocopy of the Certificate of Registration with the official receipt (both parties)
3. Photocopy of the driver´s license with the official receipt (both parties)
4. Pictures of the adverse vehicle showing the car´s plate number and the damaged portion(s)
5. Repair estimate
6. Stencil of motor and chassis numbers
7. Certificate of No Claim issued by the adverse party's insurer, supplies bought, doctor's fee, and burial expenses

Third Party Liability - Bodily Injury Claim

1. Original copy of the medical certificate, death certificate, or autopsy report
2. Original copies of the official receipt covering hospital bills, medicines and/or supplies
3. Certified true copy of birth certificate if the victim is a minor or proof of affiliation of claimant to the victim
4. Relevant pictures
5. Police report
6. Photocopy of the Certificate of Registration with the official receipt
7. Photocopy of the driver´s license with the official receipt
8. Affidavit of Desistance or Release of Claim duly signed by the BI claimant

Carnap Claim

1. Police report
2. Certificate of Registration with the official receipt
3. Photocopy of the driver´s license with the official receipt
4. Copy of Complaint Sheet led with the Anti - Carnapping Unit
5. Alarm Sheet from CHPG and Police Unit (can be obtained from the PNP Anti - Carnapping unit at Camp Crame).
6. Certificate of Non - Recovery issued by the Anti - Carnapping Unit (can be secured 90 days after the issuance of an Alarm Sheet)
7. Ignition key or spare key (to be surrendered in exchange of the settlement check)
8. Release of Chattel Mortgage, if any

Theft Claim

1. Police report
2. Photocopy of the Certificate of Registration with the official receipt
3. Photocopy of the driver´s license with the official receipt
4. Pictures of the unit showing plate number and the place where the stolen accessories were before they were stolen
5. Stereo manual for stolen stereo, or estimate of stolen accessories, etc.
6. Copy of Complaint Sheet led with the Anti - Carnapping Unit
7. Alarm Sheet from CHPG and Police Unit (can be obtained from the PNP Anti - Carnapping unit at Camp Crame)
8. Certificate of Non - Recovery issued by the Anti - Carnapping Unit (can be secured 90 days after the issuance of an Alarm Sheet)
9. Ignition key or spare key (to be surrendered in exchange of the settlement check)
10. Release of Chattel Mortgage, if any.

General Requirements

1. Original or copy of the policy including warranties and clauses attached to it
2. Pictures of the damaged properties
3. Inventory list of the insured property/ies damaged with the corresponding valuation of repair or replacement, liens and encumbrances, if any, and estimated value of salvage
4. A brief written report on the events that lead to the loss, including the name of witness/es, if available, the location/nature of ownership of the property/ies insured, and the year the building was constructed as well as the original construction cost (for building loss)
5. Arson Investigation Report or Fire Certification
6. PAG-ASA Report (for lightning, typhoon, and other weather disturbance losses)
7. Other documents that may be required by the adjuster

For Building Claim

1. Item No. 1 to 6 of the General Requirements
2. A civil engineer or architect’s detailed estimate (obtained at the expense of the insured) in order to place the building in the same state of repair as before the accident NOTE: No contemplated improvements may be included in the estimate, and/or proper allowance for age and depreciation, etc. may be allowed.
3. Appraisal report, if any
4. Copy of the building plan, complete with dimensions and design specifications
5. Lease contract or agreement, if assured is not the lot owner
6. Certified true copy of building permit, Transfer Certificate of Title and Declaration of Real Property
7. Other documents that may be required by the adjuster

For Goods and Merchandise Claim

1. Item No. 1 to 6 of the General Requirements
2. Detailed inventory of the damaged articles showing the cost price of each, extent of damage, salvage value (if any), and if the risk sustained partial or water damage
3. Proof of damage (technical report/laboratory analysis)
4. Inventory of the whole goods and merchandise in the building (for partial loss)
5. Latest inventory report, for total loss, led with the Bureau of Internal Revenue or any other government entity, prior to the loss
6. Movement reports/documents in between the last inventory report submitted and the date of loss (for total loss)
7. Production and movement report for loss in the manufacturing area
8. Certified true copies of the Income Tax Return Form together with the financial statements of the last three (3) years
9. Accounts and Purchases Books, sales invoices, and all other business records (to be made available for the adjuster ’s review)
10. Location of other store/s or warehouse and amount of insurance on stocks contained therein, if any
11. Other documents that may be required by the adjuster.

For Robbery/Burglary Claim

1. Copy of the policy with warranties and clauses attached to it
2. Insured’s report on the circumstances of the loss
3. Police investigation report
4. Affidavit or statements of witnesses (if any)
5. Inventory list of the insured property/ies with the corresponding valuation of replacement, liens and encumbrances, if any
6. Pictures showing damaged, stolen properties
7. Other documents that may be required by the adjuster

For Machinery and Equipment/FF Claim

1. Item No. 1 to 6 of the General Requirements
2. Detailed inventory of the damaged or destroyed articles showing the cost price of each and the acquisition date
3. Records, invoices, and receipts, if any (to be made available for the adjuster’s review)
4. Building contents layout
5. Other documents that may be required by the adjuster

For Pier Impact Claim

1. Copy of the policy with warranties and clauses attached to it
2. Comprehensive loss report indicating circumstances of loss
3. Marine Protest (to be led with the Philippine Coast Guard within 24 hours from the date of loss)
4. Formal claim against the vessel owner (to be led within 30 days from the date of loss)
5. Underwater survey
6. Photographs of the damaged property
7. Complete plans and design specification of the affected property
8. Detailed estimate, including bid proposals, if any
9. Technical report
10. Other documents that may be required by the adjuster

For Spontaneous Combustion Claim

1. Copy of the policy with warranties and clauses attached to it
2. Insured’s report on the circumstances of the loss
3. Laboratory analysis of the burnt product for adjustment of volume
4. Weigh scale/ticket card indicating the volume of the burnt product
5. Daily inventory/production records prior to the incident
6. Shipping/delivery records
7. Pictures of the burnt product
8. Other documents that may be required by the adjuster

Marine and Cargo Claim Requirements
1. Copy of the insurance policy with warranties and clauses attached
2. Formal advice from the insured to insurer regarding the claim
3. The following are to be submitted:
     1. Marine Risk Note and endorsement, if any
     2. Commercial invoice
     3. Bill of lading
     4. Packing lists
     5. Copies of the formal claim against the following:
          o Arrastre operator/contractor
          o Vessel's owner/agent
          o Therbailees, such as the customs broker, etc. and their respective replies
     6. Copy of delivery receipts
     7. For claims involving shipments in Bad Order condition:
          o Bad order issued by the arrastre contractor
          o Copy of the turn-over survey of the bad order on board cargoes issued by the arrastre contractor as attested by the vessel´s representative
          o Original laboratory or quality control analysis report
          o Original invoice for repair/ reconditioning of the bad order or damaged items
     8. For claims involving short-landed shipment/ spillage/ leakage
          o Bad order certificate issued by the arrastre contractor
          o Turn-over survey on bad order cargoes
     9. For claims involving short delivered shipments:
          o Short delivery or short landing certificate issued by the arrastre contractor certifying the non-discharge of packages or tally sheet of discharge

Inpatient

     o Claim Form which is duly filled and signed by:
          o Member / Insured
          o Attending physician
     o Discharge Summary / Clinical Abstract
     o Original Official Receipts (PF/Hospital Bill/Medicine)
     o Itemized and Summarized Statement of Accounts
     o Charge Slips, if any
     o Prescriptions
     o Laboratory and / or Diagnostic Request and Result
     o Police Report (if due to accident)
     o Operative Record, if with surgery

Outpatient 

     o Claim Form which is duly filled and signed by:
          o Member / Insured
          o Attending physician
     o Medical Certificate with Diagnosis
     o Original Official Receipts (PF/Hospital Bill/Medicine)
     o Charge Slips, if any
     o Prescriptions (Policies with Medicine Cover)
     o Laboratory and / or Diagnostic Request and Result
     o Police Report (if due to accident)
     o Operative Record, if with surgery

Financial Assistance 

     o Death Certificate
     o Birth Certificate
     o HMO Card
     o Certificate of Employment
     o Proof of Relationship with Beneficiary:
          o Marriage Contract (for spouse)
          o Birth Certificate (for dependent / parent)
          o Affidavit of Guardianship (for minor beneficiary)

Hospital Income 

     o Discharge Summary with Final Diagnosis
     o Statement of Account

Life 

     o Claim Form which is duly filled and signed by:
          o Beneficiary (Claimant’s Statement)
          o Attending Physician (Physician’s Statement)
     o Policy Holder’s Statement
     o Clinical Abstract / Medical Certificate
     o Clinical History (History of Present Illness)
     o Certified True Copy of Death Certificate
     o Daily Time Record
     o Certificate of Employment
     o Police Report (if due to accident)
     o Proof of Relationship with Beneficiary:
          o Birth Certificate (for dependent / parent)
          o Marriage Contract (for spouse)
          o Affidavit of Guardianship (for minor beneficiary)

Personal Accident 

     o Claim Form which is duly filled and signed by:
          o Beneficiary (Claimant’s Statement)
          o Attending Physician (Physician’s Statement)
     o Original Official Receipts (PF/Hospital Bill/Medicine)
     o Itemized and Summarized Statement of Accounts
     o Discharge Summary / Medical Certificate
     o Prescriptions
     o Laboratory and / or Diagnostic Request and Result
     o Operative Record, if with surgery
     o Incident Report
     o If due to Motor Vehicle-related accident:
          o Police Report
          o Driver's License and Vehicle Registration

AMWA 

     o Death Certificate
     o Police Report (if due to accident)
     o Clinical Abstract (for disability claims)
     o Proof of Relationship with Beneficiary:
          o Birth Certificate (for dependent / parent)
          o Marriage Contract (for spouse)
          o Affidavit of Guardianship (for minor beneficiary)
               o For Repatriation: Certification which states the reason for the termination of the migrant worker's employment issued by the Philippine Foreign Post or POLO located in the receiving county
               o For Subsistence Allowance Benefit Claims: Certification issued by the concerned Labor Attaché
               o For Settlement of Money Claims: Certified True Copy of NLRC or compromise agreement

Third Party Administration (Outpatient) 

     o Medical Certificate
     o Laboratory and Medicine Prescription
     o Official Receipts

Basic Claim Requirements:

• Insurance Claim Form (duly filled and signed by the member)
• Travel insurance policy contract
• Photocopy of Passport with pages showing dates of departure and arrival corresponding with the itinerary on the policy contract
• Flight itinerary (Original flight and revised flight details)

Additional Claim Requirements per Benefit

     1. Medical and Emergency Benefit (Inpatient)
          o Medical abstract / discharge summary
          o Statement of Account (itemized and summarized)
          o Original Official Receipts
          o Prescriptions
          o Laboratory and / or Diagnostic Request and Result
          o Police Report (if due to accident)
          o Operative Record, if with surgery

     2. Medical and Emergency Benefit (Outpatient)
          o Medical certificate specifying the diagnosis
          o Statement of Account (itemized and summarized)
          o Original Official Receipts
          o Prescriptions
          o Laboratory and / or Diagnostic Request and Result
          o Police Report (if due to accident)
          o Operative Record, if with surgery

     3. Personal Accident
          o Medical Certificate
          o Full Medical Report
          o Death Certificate
          o Police Report

     4. Baggage Loss or Damage
          o Airline Report / Incident Report
          o Police Report, for lost/stolen baggage
          o List of Items lost/stolen/damaged
          o Original Official Receipts for purchase of loss/damaged bag /items in the bag
          o Affidavit of Lost Receipt (if no O.R.)

     5. Baggage Delay Benefit
          o Airline Report / Incident Report
          o Original Acknowledge Receipt/Form stating exact date and time baggage was retrieved

     6. Strikes and Hijack Benefit
          o Airline Report / Incident Report
          o Public Documents that report the incident

     7. Hospital Income Benefit
          o Itemized/Detailed Statement of Account
          o Discharge Summary / Medical Abstract

     8. Funeral and Burial Expense
          o Death Certificate
          o Original Official Receipts of Funeral and Burial Expenses

     9. Personal Liability Benefit
          o Original Official Receipts incurred for such liability
          o Itemized/Detailed Statement of Account
          o Clinical Abstract/Medical Certificate
          o Death Certificate and Coroner's Report
          o Police Report

     10. Loss of Travel Documents Benefit
          o Original Itinerary
          o Copy of the Replacement Passport / Travel Tickets
          o Police Report
          o Original Official Receipts on the expenses incurred for the replacement of Passport / Travel Tickets

     11. Trip Cancellation or Termination
          o Proof of advance payment made for travel and accommodation expenses
          o Penalties and other irrecoverable pre-paid charges related to the trip
          o Legal documents proving trip cancellation with the specified non-refundable portion
          o Copy of the following documents:
                • Copy of Death Certificate, in case of death by insured or direct members of the family
                • Full Doctor's report on the emergency of insured or direct members of the family
                • Original Physician's declaration of patient unfit to travel
                • In case of medical treatment or death of insured's immediate family:
                    • Proof of relationship with the immediate family member (birth cert, marriage cert, etc.)
                • Proof of relationship with the immediate family member (birth cert, marriage cert, etc.)
                    • Original Police report, in case of lost travel documents
                • Public Documents (newspaper, news portal, etc.) or official advisory that report:
                • Natural catastrophes, outbreak of strike or riot, or acts of Terrorism
                • Original Irregularity Report issued by airline / carrier / airport stating reason of cancellation

     12. Flight Delay
          o Original Irregularity Report issued by airline / carrier / airport stating reason of cancellation
          o Boarding Pass
          o Original Official Receipts for expenses during delay

13. Missed Connecting Flight
     o Original Irregularity Report issued by airline / carrier / airport stating reason of cancellation
     o Boarding Passes (actual and revised)

Pre-Approval / Precertification
     • Pre-certification / pre-approval form
          • Claim Form (if no pre-certification form)
          • Filled-up and signed by member and physician
     • Laboratory and / or Diagnostic Results
     • Name of surgery, if any
     • Cost estimate with breakdown of:
          • Professional Fees (Attending, Surgeon, Anesthesiologist)
          • Hospital Fees
          • Other items
     NOTE: PLANNED ADMISSIONS/SURGERIES MUST BE FILED 10 DAYS PRIOR TO THE SCHEDULED DATE

Treatment Plan for Physio / Chemo / Radio Therapy Treatments
     • Treatment Plan Form
          • Claim Form (if no treatment plan form)
          • Filled-up and signed by member and physician
     • Laboratory and / or Diagnostic Results
     • Cost Estimate with breakdown of:
          • Number of sessions and schedule dates
          • Name of chemo drug or radioactive to be used
          • If Physiotherapy, procedure to be done
     • For additional sessions:
          • Physiotherapy report or;
          • Oncology Report
          • supporting Diagnostic Reports

Follow-Up Care Treatment
     • Follow-up Claim Form
     • Doctor’s Prescription
     • Original Official Receipts
     • Lab request and result

Dental
     • Dental Claim Form
     • Dental Report
     • Original Official Receipts
     • Itemized Breakdown of SOA:
          • Treatment done
          • Tooth number