Personal Accident Claim
PERSONAL ACCIDENT CLAIM
What to do & documents needed for personal accident insurance claim
General Documentary Requirements
- Policy/Endorsement
- Non-Waiver Agreement (Form to be provided by the Adjuster)
- Sworn Statement of Claim (Form to be provided by the Adjuster)
- Affidavit of Loss
- Pictures
Accidental Medical Reimbursement
- Police Report / Affidavit of the Claimant
- Medical Certificate, Bills & Receipts
- Physician’s Prescription (RX)
- Certificate of Insurance / Endorsement
Dismemberment / Disablement
- Police Report
- Notarized Affidavit of the Claimant
- Operating Room Record
- Detailed Clinical Summary
Hospital Income Benefit
- Police Report
- Notarized Affidavit of the Claimant
- Hospital Bill
- Hospital Discharge Summary / Admitting History
- Certificate of Insurance / Endorsement
Surgical Benefit
- Hospital Bill
- Detailed Clinical Summary
- Operating Room Record
- Certificate of Insurance / Endorsement
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
Note : Other Documents as may be needed, such as:
- Affidavit of Two Dis-Interested Person
- Certification
- Waiver of Rights
File a Personal Accident Claim
Call FGIC Claims Hotline ((+632) 8706-3939 loc. 431) or the branch office servicing nearest you to report the incident. incase either is not available, you can report a claim online.