Claims

STANDARD REQUIREMENTS FOR CLAIMS:

Marine and Miscellaneous Claim:

• Formal claim with computation
• Commercial Invoice
• Bill of Lading
• Packing Lists (for importation only)
• Formal claim with claim computation against the bailees duly Stamped received.
• Delivery receipts
• Short landed certificate (if shipment is short landed)
• Turn-over survey of bad order cargoes (if cargoes arrived in bad order)

Fire and Allied Risk Insurance Policies:
• General Requirements (For all types of claims):

1. Formal claim
2. Non-waiver agreement
3. PC – INP Anti-Arson Report
4. Police and/or Fire Department Report
5. Affidavit of Loss
6. Copy of OR of Premium Payment
7. Color photographs of property (signed by the insured at the back)

• Specific Requirements:

1. Building claim

a. Detailed estimate of the reconstruction cost of the whole (prepared by a duly licensed contractor)
b. Transfer certificate of title
c. Lease contract (if rented)
d. Building Permit
e. Appraisal report, if any
f. Building Blue Print, if any

2. Stocks claim

a. Detailed inventory of all stocks, whether damaged or undamaged, showing cost per item, extent of loss and damage.
b. Income tax returns and related audited financial statement for the last 3 years or 2 years previous to the loss.
c. Books of accounts, bills, invoices, vouchers or certified copies, if originals not available.
d. Latest itemized inventory of stocks.
e. Business licenses, permits
f. Registration of Business Name
g. SEC Certificate w/ Articles Of Incorporation or Partnership as the case may be.
h. Others to be specified.

3. Household FFF and Personal Effects

a. Detailed inventory of property at risk whether damaged or undamaged, showing date of acquisition, cost, value at the time of loss, extend to loss and damage.
b. Purchase invoices, delivery receipts and other available records pertaining to the property at risk.
c. Others to be specified.

4. Machinery, equipment, accessories

5. Fidelity Guarantee claims

a. Copy or application for employment, which was personally filled up by the involved employee with, inset machine copy of photographs.
b. Certificate of employment of the involved employee inclusive of his/her duties and responsibilities and period of employment.
c. Certificate of monies due to the erring employee by way of unclaimed salary commission, unpaid sick/vacation leaves and other similar monetary benefits.
d. Audit report inclusive of attachment such as:
▪ The DR/PR Invoice and check involved photo copied back to back.
▪ Customer’s confirmation in writing or affidavit of payment.
▪ Copies of subsidiary ledgers or computers print out showing non-posting of payments defalcated by the erring employee.
e. Copy of written internal control procedure.
f. Affidavit of the person who discovered the loss and the manner it was discovered.
g. Copies of All Assured’s memo, investigation report and the like, if any
h. Police report and statement of witnesses, if any
i. Legal documents for the filing of ESTAFA or CIVIL case against the erring employee such as:
▪ Demand letter
▪ Copy of affidavit/complaint and counter affidavit/answer together with all its Exhibits and annexes
▪ Status of the case filed; and
▪ Others.
j. Copy of policy schedule showing that the involved employee is listed thereon and OR for premium payment.
k. Copy of admission letter, if any
l. Others, in relation thereto

6. Money securities payroll receipts (Bank Robbery) and similar losses

a. Complete copy of the MSPR policy, inclusive of all endorsement list of all covered branches and OR for premium payment.
b. Investigation report of the Bank’s Security Officer, inclusive of all exhibits in the form of affidavit’s documents and other.
c. Police report and Q.A. statement of witnesses.
d. Investigation report of all banks hired security agency and inclusive OF exhibits.
e. Copy of security agreement contract between the bank and their hired security agency.
f. Mission order of all the guards assigned to the branch.
g. Written statement of all bank personnel, guards and other witnesses, as taken by the police authorities.
h. If the robbery took place in a highway and Assured used an armored vehicle or any other place outside the bank’s premises, submit further the following:
▪ Driver’s license and OR of the driver
▪ LTO Certificate of registration and OR
▪ Photographs
i. Audit report inclusive of all attachment
j. Photographs of the damaged premises, vault, drawers, chest, duffel bags and other items, for indemnity under Section IV.
k. Report of the bank to the CB of the Phils. within 48 hours and to local BIR office.
l. Court Records, if the suspects were immediately apprehended and also determine the amount of recovery by the police authorities.
m. Copy of formal written notice of claim to Insurers.
n. Photographs or Lie detector test conducted.
o. Other suspects/witnesses, if any.

7. Contractor All Risk

a. Sworn statement of Loss claim
b. Non – waiver Agreement
c. Contract of Agreement
d. Affidavit of Loss
e. Sworn Statement
f. Copy of the policy and OR of premium payment
g. Business permits and registration papers
h. Photographs
i. Statement of formal claim
j. Notice of Loss
k. Detailed repair estimate with scope of work, bill of material, diagram and technical report.
l. Incident Report
m. Police Investigation report and/or technical report
n. Project, Percentage Completion Report

8. Death and Bodily Injury (Third Party)

a. Autopsy report
b. Death Certificate
c. Receipts (medical, Burial Invoice of Funeral expense)
d. Medical certificate / records of operation
e. Hospital statement of Accounts/OR/invoices
f. X-Ray / cardiological report
g. Marriage contract / Birth certificate (of deceased and/or children)

9. Comprehensive General Liability

a. Sworn statement of Loss claim
b. Non – waiver Agreement
c. Contract of Agreement
d. Affidavit of Loss
e. Sworn statement of parties involved
f. Copy of the policy and OR of premium payment
g. Business permits and Registration papers/SEC Certificate/articles of Incorporation
h. Photographs
i. Formal Claim
j. Notice of Loss
k. Incident report
l. Police Investigation Report
m. Others

10. Property Damage

a. Registration certificate and OR of adverse vehicle / Deed of Sale
b. Driver’s license and OR of driver
c. Photographs
d. Estimate of Repair
e. Pencil stencil of the engine
f. Certificate No claim

11. All Risk

12. Equipment Floater

a. Sworn statement of Loss claim
b. Non – waiver Agreement
c. Certificate of Registration and OR of payment
d. Invoice / delivery receipts / packing slip of the equipment
e. Sworn statement of the driver
f. Driver’s license and OR of payment
g. Stencil of the motor and chassis numbers
h. Copy of policy and OR of payment
i. Business permits and Registration papers/SEC Certificate
j. Articles of Incorporation
k. Photographs
l. Formal claim
m. Notice of Loss
n. Detailed repair estimate with scope of work, bill of materials, diagram and technical findings.
o. Incident report
p. Police Investigation report

Personal Accident claim:

Medical Expense Claim

• Claim form (must be signed by his doctor/s)
• Police Report / Affidavit of Accident / Incident Report
• Company or School Certification of Accident (for company & school)
• Statement of account
• Original ORs;
◦ Hospital Official Receipt of Payment
◦ Physician’s Fee Official Receipt
◦ Medicines
• RX (prescription)
• Medical Certificate
• Picture (if Dismembered)

Accidental Death Claim

• Claim form
• Death Certificate
• Birth Certificate
• Police Report / Affidavit of Accident / Incident Report
• Company or School Certification of Accident (for company & school)
• Marriage Contract (if married)
• Medical Certification
• Medical Expenses Incurred (Official Receipt)
• Proof of relationship with the Insured.

Disablement Claim

• Claim form
• Police Report / Affidavit of Accident / Incident Report
• Company or School Certification of Accident (for company & school)
• X-Ray plate
• Diagram showing location of injury
• Picture

Weekly Indemnity Claim

• Claim form
• Police Report / Affidavit of Accident / Incident Report
• Company or School Certification of Accident (for company & school)
• Medical Certificate on extent of disability

Other documents which may be requested on a case-to-case basis

• Medical History
• Admitting History
• Doctor’s Notes
• Discharge Summary
• Operative Record
• Medical Chart
• Physical Examination Results/X-Ray Results
• Hospital Clinical Abstract/Summary
• Official Receipt, Surgeon’s & Anesthesiologist Fees
• Hospital Certification of Confinement, specifying date of admission and date of discharge.

Note: All documents requested should be in original form.

 Claim Form

The following document shall be accomplished by the Insured person and attending physician, as the case maybe. All necessary information must be furnished completely to avoid any unnecessary delay in the processing of the claim.

 Statement of Account

This document is usually by the hospital with details of the expenses incurred during confinement e.g., daily room and board expenses; hospital miscellaneous services such as medicines or drugs, x-ray examinations, laboratory tests, surgical fee, etc.

 Itemized Charged Slips of Expenses

This is important to us to properly identify whether an expense is necessary for the treatment of the injury or sickness concerned.

 Official Receipts

This will include the official receipt of the hospital issued upon the settlement of the bills, as well as the attending physician’s fee on service rendered to the claimant.

 Prescriptions

This should accompany all medicines/drugs purchased. Secure itemized invoices/receipts from the drugstore. Cash register tape receipts are not acceptable

FOR MOTOR VEHICLES

1. Police Report relating to the accident.
2. Repair Estimate, and pictures of the damage portion
3. OR and CR of the vehicle
4. Drivers License and OR

Upon completion, if within metro manila, please call 6317851 local 117 and look for Mr. Nick Dano

** if there’s no ‘police report’, execute an affidavit relating to the incident and have it annotated by a notary public

Claims

STANDARD REQUIREMENTS FOR CLAIMS:

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