How to Claim – Personal Accident Cover

• For a Hospitalisation Claim:

  [icon_list] [icon_list_item type="check"]Completed claim form.         [/icon_list_item] [icon_list_item type="check"]Detailed hospital account indicating date of admission, discharge and diagnosis.[/icon_list_item] [icon_list_item type="check"]Certified copy of the insured’s ID.[/icon_list_item] [icon_list_item type="check"]If a smart card ID has been issued, we cannot accept the green barcode ID and copies of the front and the back of the smart card ID are required.[/icon_list_item] [icon_list_item type="check"]All diagnostic tests that were done with regards to this hospitalisation.[/icon_list_item] [icon_list_item type="check"]Complete hospital file, including the medication charts, observation charts, doctor’s clinical notes, nurse’s notes, etc.[/icon_list_item] [icon_list_item type="check"]A non-specific medical history from the patients’ family doctor prior to inception of the policy.[/icon_list_item] [icon_list_item type="check"]A medical report from the treating doctor with specific reference to the first date diagnosed of the condition.[/icon_list_item] [icon_list_item type="check"]A comprehensive clinical report from the treating specialist explaining why it was clinically necessary for the patient to remain in hospital for a period of X- days including the treatment.[/icon_list_item] [icon_list_item type="check"]Pathology reports (FBC,-complete full blood count results, ESR, CRP results etc.)[/icon_list_item] [icon_list_item type="check"]Radiology report includes: Either a X-ray of the chest or a CT scan of the chest.[/icon_list_item] [icon_list_item type="check"]Hospital account reflecting diagnosis, admission & discharge dates.[/icon_list_item] [icon_list_item type="check"]Payslip for the month that you were hospitalised.[/icon_list_item][/icon_list]

• For a Total Temporary Disability Claim:

  [icon_list] [icon_list_item type="check"]Completed claim form.         [/icon_list_item] [icon_list_item type="check"]Certified copy of the insured’s ID.[/icon_list_item] [icon_list_item type="check"]If a smart card ID has been issued, we cannot accept the green barcode ID and copies of the front and the back of the smart card ID are required.[/icon_list_item] [icon_list_item type="check"]Confirmation of earnings.[/icon_list_item] [icon_list_item type="check"]Employers report of incident (for injuries on duty).[/icon_list_item] [icon_list_item type="check"]Initial, progress and final medical reports from the treating doctor.[/icon_list_item] [icon_list_item type="check"]Resumption report from the employer.[/icon_list_item] [icon_list_item type="check"]Medical certificates from the treating doctor/s indicating the TTD dates.[/icon_list_item][/icon_list]

• For a Total Permanent Disability Claim:

  [icon_list] [icon_list_item type="check"]Completed claim form.         [/icon_list_item] [icon_list_item type="check"]Certified copy of the insured’s ID.[/icon_list_item] [icon_list_item type="check"]If a smart card ID has been issued, we cannot accept the green barcode ID and copies of the front and the back of the smart card ID are required.[/icon_list_item] [icon_list_item type="check"]Confirmation of earnings.[/icon_list_item] [icon_list_item type="check"]Employers report of incident (for injuries on duty).[/icon_list_item] [icon_list_item type="check"]Initial, progress and final medical reports from the attending doctors / specialists indicating the following:

  • The injuries sustained in the accident.
  • The prognosis and whether the condition is likely to improve with further treatment.
  • When is the condition likely to stabilise.
  • Indicate the functional impairments and express as a percentage (%) the extent of possible permanent disability.
  • Is the insured likely to resume his usual or any occupation?

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