Note : Other Documents as may be needed, such as:
Affidavit of Two Dis-Interested Person Certification Waiver of Rights
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Personal Accident Claims Claim Types
Death
Death Certificate Police Report Notarized Affidavit of the Claimant Proof of Relationship to Beneficiary Certificate of Insurance / Endorsement -If claim is accident related -If due to illness
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Surgical Benefit
Hospital Bill Detailed Clinical Summary Operating Room Record Certificate of Insurance / Endorsement
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Hospital Income Benefit
Police Report Notarized Affidavit of the Claimant Hospital Bill Hospital Discharge Summary / Admitting History Certificate of Insurance / Endorsement
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Dismemberment / Disablement
Police Report Notarized Affidavit of the Claimant Operating Room Record Detailed Clinical Summary
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Accidental Medical Reimbursement
Police Report / Affidavit of the Claimant Medical Certificate, Bills & Receipts Physician’s Prescription (RX) Certificate of Insurance / Endorsement
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