FAQ's for Personal Accident Claims
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1.WHAT IS THE FIRST STEP THAT I NEED TO TAKE IN EVENT OF A LOSS?
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In case of an unfortunate event of accident to insured, first of all take care of your health and consult doctor. Notify police authorities wherever necessary. Please contact USGIC by any of the following convenient ways: MODE OF CONTACT DETAILS 1. Email advise can be sent at contactclaims@universalsompo.com 2. Call on our Toll Free number 1-800-22-4030 (from MTNL & BSNL Lines) 3. Helpline number 022-41582900 - 41582999 In case of telephonic contact, our call centre executive shall note down the basic requirements and pass on the information to the concerned Claims Team who shall appoint an investigator(if required), to assess the case in stipulated time.
In case the claim is being notified by email, the attached I claim notification to be filled in and sent to enable the concerned claims handler to contact you immediately for further update.
In a rare case that you find it difficult to communicate through any of the above modes, you may immediately inform the loss to your nearest USGIC office or banker (for Banca policies) who shall contact us for further formalities.
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2.HOW DO I KNOW IF MY LOSS IS COVERED UNDER THE POLICY?
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You can do a self check to see if the answers to the following questions are "YES"
Premium - is your premium check cleared by the bank?
Period - whether the insurance is in force at the time of loss?
Peril - whether the cause of loss is covered by the policy? (Perils are defined in the policy document)If your answers to the above questions are "YES", then your loss stands covered by us, subject to policy terms and conditions.
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- 3.WHAT IS THE QUANTUM OF CLAIM THAT I RECEIVE?
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4.WHO RECEIVES THE CLAIM PAYMENT?
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We pay the amount to the Insured. In case of death claim, the amount is paid to the nominee of the policyholder. In case there is no nominee made under the policy, then USGIC will insist upon a succession certificate from a court of law for disbursing the claim amount. Alternatively, the USGIC can deposit the claim amount in the court for disbursement to the next legal heirs of the deceased.
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- 5.WHAT IF THE ACCIDENT TAKES PLACE IN A CITY OTHER THAN WHERE THE POLICY WAS ISSUED?
- 6.DO I NEED TO REPORT THE ACCIDENT TO THE POLICE?
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7.WHAT IS THE CLAIM PROCEDURE AFTER THE CLAIM IS NOTIFIED?
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We shall take the following steps immediately once the claim is notified to us:
The investigator shall be appointed.
The investigator, after inspection shall assess the loss and inform the assessment to the insurer.
Claim processing-Within seven working days from the date of receipt of all requisite documents.
Claims Payment- Within two working days from the finalization of claim.
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- 8.HOW DO I GET A CLAIM FORM?
- 9.WHAT ARE THE BENEFITS I WOULD GET IN CASE OF PARTIAL PERMANENT DISABILITY DUE TO AN ACCIDENT?
- 10.IF I AM DISABLED DURING AN EARTHQUAKE, WILL I GET COMPENSATION?
- 11.IF DEATH OCCURS DUE TO DISEASE OR IT'S NATURAL, WILL THE CLAIM BE PAID?
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12.WHAT ARE THE BENEFITS USGIC IS PROVIDING IN PERSONAL ACCIDENT POLICY?
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Basic cover - Death only
Wider cover - Death + Permanent Total Disability+ Permanent Partial Disability
Comprehensive cover - Death + Permanent Total Disability + Permanent Partial
Disability +Temporary Total Disability
Extra benefits under policy in addition to capital sum insured, 1) Transportation cost for carriage of dead body to home including funeral charges.
2) Cost of clothing damaged in the accident.
3) Ambulance charges for transportation of insured person to hospital following accident.
4) Education fund in the event of death, PTD of the proposer for up to two dependent children.
5) Loss of employment
ADD-ON Covers-(only on receipt of additional premium)
1) Medical expenses.
2) Hospital confinement amount.
THE SCOPE OF COVERAGE SHALL DEPEND ON THE BENEFIT SELECTED BY YOU AND AS DESCRIBED IN THE SCHEDULE.
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- 13.WHAT ARE THE CLAIM DOCUMENTS NECESSARY FOR CLAIM SETTLEMENT?
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14.WHAT ARE THE CLAIM DOCUMENTS NECESSARY FOR CLAIM SETTLEMENT?
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List of Documents Death Death Claim Temporary Total Disability(TTD) Permanent Total Disability Permanent Partial Disability Duly filled original Claim Form X X X X Policy copy X X X X Claim Intimation X X X X FIR-Attested or Original X X X X Death Certificate X Post Mortem report X Inquest/Coroner's Report X Final Police Report/Original Panchnama X X X X Legal Heir certificate /nominee certificate X Confirmation of coverage letter X X X X Discharge summary of the treating hospital clearly indicating the Hospital Registration No. X X X Diagnostic reports X X X Leave certificate X Certificate from government hospital doctor confirming the nature and degree of disability X X X Termination letter for claim under "Loss of Employment" X Photograph of the injured with reflecting disablement X
*Any other documents as and when requested by the claim settling authority
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