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Frequently Asked Questions
Health insurance will shield you and your family against any financial unforeseen event arising due to a medical crisis.
It is an Identity card which is issued to each and every person covered under the Health policy. This card would entitle you to avail cashless hospitalization facility at any of our network hospitals.
Policyholders are eligible for health card.
A health card mentions the contact details the TPA. In case of a medical emergency, you can call on these numbers for queries, clarifications and for seeking any kind of assistance. You need to show the health card at the hospital.
The health cards need to be renewed or re-issued during the policy tenure.
Third Party Administrator is a service provider appointed by your insurance company to provide various necessary services related to benefits mentioned in the health policy to you.
Any condition, ailment, injury or related condition(s) for which you had signs or symptoms, and / or were diagnosed, and/ or received medical advice / treatments within stipulated months as mentioned in your policy prior to your first policy with us.
Pre-existing diseases are covered subject to waiting period as mentioned in your policy.
Spouse
Dependent Children means all unmarried children, stepchildren or legally adopted children who are above 91 days and under 23 years of age and are financially dependent on Insured
Dependent Parents upto 70 years of age.
In case of a planned hospitalization or emergency services, use your Health ID Card at any of network hospitals and avail cashless service. In case the hospital is not listed in the network of hospital, then pay the cash and submit the claim to TPA for reimbursement with relevant documents and bills.
These are the hospitals that form part of the TPA's network to provide cashless service to you upon presentation of health-card.
Hospitals which are not part of TPA's hospital tie-up list are called Non-network hospital. The bills are settled by patient & the relevant documents and bills are then submitted to the TPA. The amount, accordingly, is reimbursed to the patient.
List is provided to you along with your health card which is issued by TPA. This list is subject to change and updated list is available on TPA website.
When you approach a hospital which is listed in the provider list of our network and disclose the health-card, hospital will pursue TPA for pre-authorization. Once the authorization is issued by TPA, you do not have to pay any money towards the covered services provided by the hospital. This is called as a cashless service.
It is a hospital request to TPA to confirm the pay ability of your illness.
In case of planned hospitalization:
Please contact your TPA helpline-Which is mentioned on the Health Identity Card. Obtain approval from the TPA.
In case of emergency hospitalization:
Family to contact TPA help-line as mentioned in the policy.
TPA will issue the letter of admissibility of the claim within 3-6 hours provided all the relevant documents are submitted.
Duly completed claim form
Original bills, receipts and discharge certificate/card from the hospital.
Original bills from chemists supported by proper prescription.
Information and evidences from the attending Medical
Practitioner/Hospital/Chemist/Laboratory as required.
The claim must be filed within 30 days from the date of discharge from the Hospital or completion of treatment.
Normally, the bills are settled within 7 working days of receiving the relevant documents.
Once you stop paying the premiums, the policy would be discontinued.
Once you stop paying the premiums, the policy would be discontinued.
Yes, there is a tax benefit available under Section 80D of the income tax act 1961. Every tax payer can avail an annual deduction of Rs. 15,000 from taxable income for payment of Health Insurance premium for self and dependants.
Yes, you can have more than one Health Insurance policy. In case of a claim, each company will pay ratable proportion of the loss.
You are allowed to claim insurance only once in a year?
Yes, foreigners living in India can be covered under a health insurance policy. However, the coverage would be restricted to India.
Frequently Asked Questions
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.
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.
The amount of claim generally payable depends on the type of policy, policy coverage and policy terms and conditions.However,in no circumstance will the total amount of claim exceed the sum insured of your policy.
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.
It doesn't matter where the accident happens. We shall co-ordinate through our offices and network to ensure that you are guided through the procedures without any hassles.
Yes
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.
A form is included in the policy kit that you must have received. However for your convenience our representatives will supply the claim form for you. The claim form is available on our company website www.universalsompo.com
The benefits will depend on the extent and type of disability. (Please refer policy documents.)
No. This cover is applicable only if the disability is due to an accident. A disability caused due to a natural calamity is not covered.
No. This cover is applicable only if the death is due to an accident. A death caused due to a disease or natural death is not covered..
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.
No. This cover is applicable only if the death is due to an accident. A death caused due to a disease or natural death is not covered.
| 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 |
Frequently Asked Questions
As soon as your vehicle meets with an accident or injures a third party or damages the property of a third party, inform us on our contact centre (contact details below). Our claims executive will get in touch with you and guide you on the procedures and documents necessary to process your claim.
| 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 | +91-22-27639800 |
It is in your interest not to drive the damaged vehicle using its own power since any consequential damages after accident would not be admissible under the policy.
It doesn't matter where the accident happens. We shall co-ordinate through our offices and network to ensure that you are guided through the procedures without any hassles.
You need to obtain an FIR in any of the following cases:
Bodily Injury to any Third Party involved in the accident.
Theft of the entire vehicle or accessories, other vehicle parts.
Any loss or damage to the vehicle by miscreants, rioters, terrorists, arsonists, etc.
For all commercial vehicles.
Yes. Spot survey is compulsory for commercial vehicles.
Yes,provided you have 'Own Damage' coverage under your policy. This off-course will be subject to the terms, condition and exclusion of the policy.
As per the Motor Vehicle Act 1938, no vehicle can play on public roads without the Third Party insurance coverage; Third Party insurance covers the following:
Any injury / death of third person caused by your car.
Any damage caused to the property of some other individual by your vehicle.
Only third party insurance liability coverage does not cover loss or damage to your insured vehicle.
If you are having a Theft or Act only policy, accidental damages to your vehicle would not be covered. Only Theft of vehicle is covered under Theft Policy. Similarly third part liability will be covered under Act policy.
We shall take the following steps immediately once the claim is notified to us :
The surveyor shall be appointed within 24 hours from the time of notification.
The surveyor, after inspection shall assess the loss and inform the assessment to the insured.
The surveyor shall carry out the re-inspection after the repairs are completed. Post Repairs - Non Cashless Workshop Insured have to make the payment to the workshop.
Original repair invoice and payment receipt needs to be submitted to us.
Claim amount will be settled within seven working days after receiving the final documents.
Post Repairs - Cashless Workshop
In case of USGIC Cashless Workshops, you only have to pay the difference amount as informed to you by our surveyor and the workshop shall submit their bill for the balance amount directly to us.
A form is included in the policy kit that you must have received. However for your convenience our representatives will supply the claim form for you. The claim form would also be available on our company website www.universalsompo.com
Surveyor will come to the workshop where the vehicle will be left for repairs in case it is not a Spot survey.
No problems. Our call centre will assist you to get your vehicle towed to our Cashless Workshops. However if you choose to use a garage of your choice, you shall have to arrange for the towing of vehicle and reasonable towing charges shall be reimbursed based on the policy terms and conditions.
We have no problems, but there shall be no cashless facility and you will have to make the payment to the garage in full and submit the final bills and receipt to us for processing.
You shall have to bear:
The amount of depreciation as per the rate indicated in the policy document.
Compulsory deductible under the policy.
Voluntary deductions under the policy, if you have opted for it.In case of any claim during the insured policy period, at the time of renewal, you will loose the NCB 'No Claim Bonus' that you have accrued over the years. Also there could be a loading on the premium at the time of renewal.
Immediately notify the loss to the nearest police station from the place where the vehicle was stolen and also intimate the same to us at our call centre. Our claims executive shall get in touch with you and assist you for further course of action.
If your vehicle is insured under comprehensive insurance policy and the person driving your vehicle holds a valid driving license, these damages are covered subject to terms and conditions of the policy.
Yes. If you have paid an additional premium to get coverage of Personal Accident to the insured or any named person other than paid driver or cleaner. This is usually applicable to private cars and motorized two wheelers.
If you have taken a comprehensive policy for your vehicle you are fully covered against all the accidental damages to your vehicle. Your are also covered for the Third Party liability subject to terms and conditions mentioned in the policy document.
If your vehicle under hire purchase or hypothecation is a total loss on account of accident damage or theft, the claim is paid to the hypothecator with whom the vehicle is leased/hypothecated. However, if the damage can be repaired, the claim is normally paid to the vehicle owner. If a cashless repair facility is used, then the amount is paid to the dealer where the vehicle has been repaired.
No, each loss has to be separately intimated to us and surveyed as per procedure.
No, your vehicle must first be repaired, after which we shall process and settle the claim based on the policy terms and conditions.
The insured vehicle shall be treated as a Constructive Total Loss, if the aggregate cost of retrieval and/or repair of the vehicle subject to the terms and conditions of the policy, exceeds 75% of the IDV of the vehicle. Total Loss also refers to accident damage to your vehicle where the cost of repairs amounts to more than 75% of the IDV on your policy.
The insured vehicle shall be treated as a Constructive Total Loss, if the aggregate cost of retrieval and/or repair of the vehicle subject to the terms and conditions of the policy, exceeds 75% of the IDV of the vehicle. Total Loss also refers to accident damage to your vehicle where the cost of repairs amounts to more than 75% of the IDV on your policy.
An excess is the amount first loss that you shall have to bear.
This is the amount you have opted to be deducted from claim amount at the time of purchase of insurance.
This is in addition to compulsory excess applicable by the policy.
Frequently Asked Questions
In case of an unfortunate event of damage to your insured property or an injury to any third person consequent to use of your insured property, you need to immediately contact us. In a rare case that you find it difficult to communicate through any of the above modes, you may immediately inform of the loss to your banker who shall contact us for further formalities. your claim.
Unless it is required by local authorities, please do not disturb the location of loss so that the surveyor can get first hand information of the circumstances of loss. In cases like fire or burglary, please lodge requisite complaints immediately to the local authorities. It is very important that you take immediate and suitable actions to minimize the loss for all concerned. Remember, it is your property and it is in your interest to ensure the loss is restricted to a minimum.
Though we shall provide all assistance to you for assessing the loss, however, a delayed notification would mean alteration of pristine circumstance of the loss and hence will entail additional enquiries and documents by the surveyor. It is in your interest to report a loss immediately and leave the burden of further procedures on us.
A surveyor is an independent professional duly licensed by IRDA who is appointed based on the nature and quantum of estimated loss to visit the accident site and procure first hand information relating to the cause and extent of loss. He shall verify the damaged property and check documents related thereto. The sooner you submit the documents requested by surveyor, the faster he finalizes his report and our claims team shall process the claim without any delay.
Never mind, inform both of us simultaneously sharing insurance details and we shall take it up with your other insurer to ensure that there is no hindrance to your claims process.
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)
Property - whether the property said to be affected is insured by the policy?
Place - whether the location of loss is covered by the policy?
Person - whether you have an insurable interest in the damaged property?
If your answers to the above questions are "YES", then your loss stands covered by us, subject to policy terms and conditions.
The amount of claim generally payable depends on the value of the affected property less residual value of damaged property less under-insurance, if any, less compulsory excess as defined in your policy. However, in no circumstance will the total amount of claim exceed the sum insured of your policy.
We pay the claim to the Insured. If the damaged property is hypothecated to your banker, then we pay in the name of your banker, however, if you can obtain an NOC from your hypothecator, we have no problem in paying the claim to you.
Frequently Asked Questions
In case of an unfortunate event of damage to your insured property or an injury to any third person consequent to use of your insured property, you need to immediately contact us. In a rare case that you find it difficult to communicate through any of the above modes, you may immediately inform of the loss to your banker who shall contact us for further formalities. your claim.
Unless it is required by local authorities, please do not disturb the location of loss so that the surveyor can get first hand information of the circumstances of loss. In cases like Engineering or burglary, please lodge requisite complaints immediately to the local authorities. It is very important that you take immediate and suitable actions to minimize the loss for all concerned. Remember, it is your property and it is in your interest to ensure the loss is restricted to a minimum.
Though we shall provide all assistance to you for assessing the loss, however, a delayed notification would mean alteration of pristine circumstance of the loss and hence will entail additional enquiries and documents by the surveyor. It is in your interest to report a loss immediately and leave the burden of further procedures on us.
A surveyor is an independent professional duly licensed by IRDA who is appointed based on the nature and quantum of estimated loss to visit the accident site and procure first hand information relating to the cause and extent of loss. He shall verify the damaged property and check documents related thereto. The sooner you submit the documents requested by surveyor, the faster he finalizes his report and our claims team shall process the claim without any delay.
What if I have a separate insurance policy with insurance company for the same property?
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.
The amount of claim generally payable depends on the type of policy, policy coverage and policy terms and conditions.However,in no circumstance will the total amount of claim exceed the sum insured of your policy.
We pay the claim to the Insured. If the damaged property is hypothecated to your banker, then we pay in the name of your banker, however, if you can obtain an NOC from your hypothecator, we have no problem in paying the claim to you.
Frequently Asked Questions
In case of an unfortunate event of damage to your insured property or an injury to any third person consequent to use of your insured property, you need to immediately contact us. In a rare case that you find it difficult to communicate through any of the above modes, you may immediately inform of the loss to your banker who shall contact us for further formalities. your claim.
Unless it is required by local authorities, please do not disturb the location of loss so that the surveyor can get first hand information of the circumstances of loss. In cases like Engineering or burglary, please lodge requisite complaints immediately to the local authorities. It is very important that you take immediate and suitable actions to minimize the loss for all concerned. Remember, it is your property and it is in your interest to ensure the loss is restricted to a minimum.
Though we shall provide all assistance to you for assessing the loss, however, a delayed notification would mean alteration of pristine circumstance of the loss and hence will entail additional enquiries and documents by the surveyor. It is in your interest to report a loss immediately and leave the burden of further procedures on us.
A surveyor is an independent professional duly licensed by IRDA who is appointed based on the nature and quantum of estimated loss to visit the accident site and procure first hand information relating to the cause and extent of loss. He shall verify the damaged property and check documents related thereto. The sooner you submit the documents requested by surveyor, the faster he finalizes his report and our claims team shall process the claim without any delay.
What if I have a separate insurance policy with insurance company for the same property?
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.
The amount of claim generally payable depends on the type of policy, policy coverage and policy terms and conditions.However,in no circumstance will the total amount of claim exceed the sum insured of your policy.
We pay the claim to the Insured. If the damaged property is hypothecated to your banker, then we pay in the name of your banker, however, if you can obtain an NOC from your hypothecator, we have no problem in paying the claim to you.
Frequently Asked Questions
In case of an unfortunate event of damage to your insured property or an injury to any third person consequent to use of your insured property, you need to immediately contact us. In a rare case that you find it difficult to communicate through any of the above modes, you may immediately inform of the loss to your banker who shall contact us for further formalities. your claim.
Unless it is required by local authorities, please do not disturb the location of loss so that the surveyor can get first hand information of the circumstances of loss. In cases like Engineering or burglary, please lodge requisite complaints immediately to the local authorities. It is very important that you take immediate and suitable actions to minimize the loss for all concerned. Remember, it is your property and it is in your interest to ensure the loss is restricted to a minimum.
Though we shall provide all assistance to you for assessing the loss, however, a delayed notification would mean alteration of pristine circumstance of the loss and hence will entail additional enquiries and documents by the surveyor. It is in your interest to report a loss immediately and leave the burden of further procedures on us.
A surveyor is an independent professional duly licensed by IRDA who is appointed based on the nature and quantum of estimated loss to visit the accident site and procure first hand information relating to the cause and extent of loss. He shall verify the damaged property and check documents related thereto. The sooner you submit the documents requested by surveyor, the faster he finalizes his report and our claims team shall process the claim without any delay.
What if I have a separate insurance policy with insurance company for the same property?
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.
The amount of claim generally payable depends on the type of policy, policy coverage and policy terms and conditions.However,in no circumstance will the total amount of claim exceed the sum insured of your policy.
We pay the claim to the Insured. If the damaged property is hypothecated to your banker, then we pay in the name of your banker, however, if you can obtain an NOC from your hypothecator, we have no problem in paying the claim to you.
Frequently Asked Questions
In case of an unfortunate event of damage to your insured property or an injury to any third person consequent to use of your insured property, you need to immediately contact us. In a rare case that you find it difficult to communicate through any of the above modes, you may immediately inform of the loss to your banker who shall contact us for further formalities. your claim.
Unless it is required by local authorities, please do not disturb the location of loss so that the surveyor can get first hand information of the circumstances of loss. In cases like Engineering or burglary, please lodge requisite complaints immediately to the local authorities. It is very important that you take immediate and suitable actions to minimize the loss for all concerned. Remember, it is your property and it is in your interest to ensure the loss is restricted to a minimum.
Though we shall provide all assistance to you for assessing the loss, however, a delayed notification would mean alteration of pristine circumstance of the loss and hence will entail additional enquiries and documents by the surveyor. It is in your interest to report a loss immediately and leave the burden of further procedures on us.
A surveyor is an independent professional duly licensed by IRDA who is appointed based on the nature and quantum of estimated loss to visit the accident site and procure first hand information relating to the cause and extent of loss. He shall verify the damaged property and check documents related thereto. The sooner you submit the documents requested by surveyor, the faster he finalizes his report and our claims team shall process the claim without any delay.
What if I have a separate insurance policy with insurance company for the same property?
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.
The amount of claim generally payable depends on the type of policy, policy coverage and policy terms and conditions.However,in no circumstance will the total amount of claim exceed the sum insured of your policy.
We pay the claim to the Insured. If the damaged property is hypothecated to your banker, then we pay in the name of your banker, however, if you can obtain an NOC from your hypothecator, we have no problem in paying the claim to you.
Health Claim Process
Universal Sompo- Health Claim Management
“Cashless facility” is a facility extended by the insurer to the insured where the payments of the costs of treatment undergone by the insured in accordance with the policy terms and conditions are directly made to the network provider by the insurer to the extent Cashless/ Pre-authorization approved
The insured or the network service provider seeks an approval and guarantee of payment from the insurer before the hospitalization for planned treatment and during Hospitalization for emergency treatment
You can avail the cashless hospitalization facility in any of our Network Hospital. Click here to Search Network Hospital.
Step I
Call our Health Helpline 1800 200 4030 and Intimate your Claim within 24 hrs in case of emergency admission and 48 hrs prior to hospitalization in case of planned admission.
Step II
Visit Network hospital and show your Health Serve Card issued by the company along with Valid Photo ID proof and get ‘Cashless Request Form’ from Insurance helpdesk of the hospital
Step III
Fill your details in the ‘Cashless Request Form’ & submit it to the Hospital Insurance helpdesk
Step IV
Hospital verifies the patient details and sends duly filled Cashless Request Form by mail to Universal Sompo Health team at healthserve@universalsompo.com
Step V
Universal Sompo – Health willreview and judge the admissibility of the Cashless Request as per Policy Terms &Conditions and the same will be communicated to you and hospital. You will be required to pay for expenses that are not payable as per the terms and condition of the policy.
Reimbursement claim is when the expenses incurred during Hospitalization or bills of Hospitalization are directly settled by the Insured with the Hospital and post discharge from Hospital claimed by the Insured from the Insurer for reimbursement.
Step I
Call our Health Helpline 1800 200 4030 or email at healthserve@universalsompo.com and inform about your Claim within 24 hrs in case of emergency admission and 48 hrs prior to hospitalization in case of planned admission.
Step II
Visit hospital and undergo your treatment. Settle your hospitalization bill and collect all original documents after discharge from hospital
Step III
Fill in Reimbursement Claim Form and submit all original documents to our below mention office for reimbursement.
Universal Sompo General Insurance Company Limited
Health Claims Management Office,
1st Floor, Plot No. C 56 A/13,
Block C, Sector- 62, Noida,
Uttar Pradesh- 201309
Step IV
On receipt of document your claim will processed as per Terms & Conditions of policy and the same will be communicated to you.
As soon as a claim occurs, please intimate to the TPA Help line/Toll free number as mentioned in your Health Card. For cashless hospital and more information kindly visit our TPA web site link mentioned below.
Our TPA will be glad to provide you services with a smile within the overall terms and conditions of your MEDICLAIM policy. Our TPA will provide you the following claims services:
- "Cashless Service" at all our Network Providers for all eligible ailments/conditions.
- Processing and settlement of claims under the MEDICLAIM policy with a time bound approach.
- 24 hours Call Centre Service.
Following information needs to be furnished by you while intimating a claim:
- Your Contact Numbers
- Policy Number and Membership ID number (as reflecting on the Health Card)
- Name of Insured person who is Sick or Injured,
- Nature of Sickness/Accident,
- Date & Time of Loss in case of accident, commencement date of symptom of disease in case of sickness,
- Location of Loss,
- Place & contact details of the Insured Person.
- Claim form duly filled out and signed by the Insured.
- Certificate from attending medical practitioner mentioning the first symptoms and date of occurrence of ailment.
- All treatment papers of current ailment including previous treatment papers if any.
- Original Discharge Card from the hospital.
- All original medical Investigation reports (viz. X-ray, ECG, Blood test etc).
- Original hospital bill and receipts.
- Original bills of chemist, medical practitioner, medical investigation, etc. supported by the doctor’s prescription.
- NEFT details and Personalized cancelled cheque/ Pass book copy in the name of proposer for electronic fund transfer.
- Valid Photo ID Proof and address proof of the patient.
- For accident Cases: MLC (Medico Legal Certificate) /FIR (First Information report).
- Submit copy of latest valid address proof of proposer like electricity bill, water bill or telephone bill or updated bank statement along with copy of PAN card & Aadhaar Card as per AML/KYC Norms.
- As per Aadhaar Regulations, please submit copy of masked Aadhaar Card or please ensure first 8 digits of Aadhaar card are masked and only last 4 digits are visible.
Kindly retain a copy of the documents sent to us, for your future reference. The above list of documents is indicative. In case of any further document requirement, Our Health Serve team will contact you on receipt of your claim documents by us
| Particulars | Transaction Type | Turn Around Time (TAT) |
|---|---|---|
| Cashless Approval | Initial Authorization | 60 mins |
| Discharge Request | 3 Hrs | |
| Claim Settlement | 15 Days |
Travel Claim Process
Travel Insurance provides you and your family medical, financial and other assistance in case of an emergency or untoward circumstances while travelling on an International Trip.
No matter what you are: a business traveller or a leisure traveller: you are now safer with Overseas Travel Insurance which protects you from unfortunate events such as loss or delay in checked baggage, passport loss, a medical emergency or an Accident
| Jurisdiction | Worldwide coverage for Medical & Travel related assistance | |
|---|---|---|
| TPA | Falck India Pvt Ltd | |
| Location of centre | Haryana, India | |
| Address |
Falck India Pvt Ltd Upper Floor The Peach Tree, Block – C Sushant Lok – I Sector 43, Gurugram Haryana – 122015 |
|
| Toll-Free Numbers for assistance | 18775367264 | |
| Other Telephone Numbers | +91 1244498766 | |
| Fax Numbers | +91 1244006674 | |
| Email id | UniversalSompo@falck.com | |
| Website | www.falck.com |
- To lodge a claim, you should immediately contact the Helpline numbers of the Overseas Assistance Provider providing the necessary details. The Details of the Alarm Centre are as mentioned above.
- You need to contact the Alarm Centre number while abroad as soon as possible and inform in case You will be filing - any claim, even if assistance is not required. We will not be liable to pay any claim on return back to India, that has not been informed by You, while abroad to the Alarm Centre
- The Alarm Centre, will verify the identity of the caller by asking his name passport number
- In the event of an accident or sudden illness where it is not possible to do sobefore consulting a Medical Practitioneror going to the Hospital, You shall contact the Alarm Centre as soon as possible. In either case, when being admitted as a patient, you shall show the concerned Medical Practitioneror personnel this Policy, if requested.
- In case of Financial Emergency, You shall immediately contact the Alarm Centre stating the details given on Your Insurance Policy along with the police report containing the passport number and a written statement narrating the incident of loss i.e. causes, circumstances and the place. Failure to do so may prejudice Your claim, as Our liability will only attach in case of claim supported by above documents.
- In case of Hijacking, the fact of the incident having occurred should be confirmed by the proper police authorities. The police report should contain details such as the passport number of the Insured, the period of hijack, etc. In rare casesWe may consider the other supporting documents such as a report issued by the airlines, newspaper reports, TV and other media coverage with regard to the particular hijacking incident.
- If the procedure stated above is complied with, the Overseas Assistance Provider, as the case may be, will guarantee to the service provider the costs of hospitalization, transportation for emergency services, transportation home for You and any covered accompanying person and Financial Emergency Assistance. All costs will be directly settled by the Overseas Assistance Provider on Our behalf and the same shall constitute due discharge of Our obligations hereunder.
- If the service provider does not accept the guarantee of payment from the Overseas Assistance provider, we cannot be held responsible for the same. The relevant costs will then have to be borne by you. These costs will then be considered for reimbursement by - Us or the Overseas Assistance Provider on submission of required documents.
- Reimbursement of all claims (except claims under Financial Emergency Assistance) will be made by the Overseas Assistance Provider in Indian Rupees on the insured's return back to the Republic of India, at the exchange rate specified by the Reserve Bank of India, as applicable on the date the amount is billed
- Claims under Financial Emergency Assistance shall be settled/arranged directly to You, whilst abroad, by the Overseas Assistance Provider
- In case of burglary loss at the home of the insured whilst on the trip abroad, the loss is to be intimated to the Overseas Assistance Provider in India
The company shall appoint an independent surveyor to assess the loss.
| DO'S | DONT's |
|---|---|
| Do make sure you take out your insurance before you travel. It can be very difficult to arrange once your holiday has started. Normally, insurers will not grant cover once a journey has commenced, leaving you exposed to a significant financial risk and a delay in the assistance you may desperately need. | Don't think that buying travel insurance is an unnecessary extra expense on top of your holiday cost. At worst it can help you get the assistance you need - at best it could help save your life. |
| Do make sure that you have disclosed any pre-existing medical conditions to your insurer when you take out the policy (including yourself and your dependent family). | Don't arrange your own evacuations/repatriation unless your life is in danger without it and you and your companions cannot talk to the insurer in time. Otherwise, they won't pay if evacuation is self-arranged. |
| Do ensure that you take all documentation of your travel policy with you on holiday, especially the emergency assistance telephone number. | Don't keep your properties, travel documents unattended. Keep your valuables in hotel lockers/safe deposit vaults. |
| Do be aware that a 'low cost' policy may not provide a level of cover you require; often 'low cost' means 'low cover' and a less-than-reassuring service when you most need it! | Don't accept lavish hospitality extended by strangers/ unknown persons especially while shopping for jewellery and expensive items. |
| DO contact the Assistance & claim-settling Co. for assistance and inform immediately, with full details. The insured can contact Falck India Pvt Ltd which will provide emergency assistance and claims administration services guidance. | Don't get admitted in a hospital merely for investigation, evaluation or health checkups- It will not be approved. |
| In extreme emergency medical conditions prohibiting getting in touch with assistance co., get admitted to the nearest facility/hospital. Request your representative to contact the assistance and claim settling co for further process. | Don't forget to record the details of damage caused to any property or injury to anyone involved.. |
| For reimbursement claim please intimate ASAP to Falck India Pvt Ltd via fax/ email and seek documentation advice before return from abroad. | Don't claim the following expenses:- Telephone/fax , food and beverages , documentation charges, |
| DO keep all Original bills and receipts, travel documents, original medical reports for easy process of reimbursement claim. | Don't panic, If you receive a bill or notice from a provider or collection agency, simply forward it to Falck India Pvt Ltd by the quickest means possible (fax or e-mail), and to take action directly with the provider. |
| Loss of baggage must be reported to the carrier and a Property Irregularity Report to be obtained. You may also claim from the carrier for they negligence. | Don't admit any liability without written consent of Falck India Pvt Ltd to any party in what so ever form. |
| In case of loss of passport, the police authorities to be informed, contact the nearest Indian embassy for further guidelines? | Don't be reckless and always safeguard yourself from unhealthy event or circumstance as if the insurance is not in force. |
| Do- in case of financial emergency, the insured can contact the claim-settling co. stating details of insurance policy, Police report, and a written statement narrating the incident of loss. | Do not call Falck India Pvt Ltd without policy details available. |
| In case of Out Patient treatment (OPD) kindly forward the original papers to Falck India Pvt Ltd Haryana office. | |
| Do take and keep detailed notes of all conversations with insurance company representatives, and get names, phone numbers, and job titles of people you speak with. | |
| Do take pictures, if possible, of damage to your vehicle, the accident scene, and your injuries. | |
| DO be honest and forthcoming with your insurer. Even if it is embarrassing, it is better if your insurer knows all the facts. Failing to be candid with your insurer might invalidate your policy or cause a denial of coverage. | |
| Please send claim papers for reimbursement cases within 30 days from the date of return to India. |
Personal Accident Claim Process
In event of any claim arising due to accident, please intimate immediately to
- Our nearest office or
- On our call centre number or on toll free number 1-800-22-4030 (from MTNL & BSNL Lines.)
- Write to us on contactus@universalsompo.com
Our claims officials shall soon get in touch with you and shall be happy to help you with the claim procedures.
Details of our offices can be found in the USGICL Office Locator in our Website.
Following information needs to be furnished by you while intimating a claim:- Your Contact Numbers
- Policy Number
- Name of Insured person,
- Date & Time of accident,
- Place of accident,
- Brief description on incident.
- Place & contact details of the Insured Person.
-
Generic Documents for all claims
(Accidental Death, Permanent Total Disability & Critical Illness)
- Duly filled original Claim Form along with duly filled Bank Mandate Form & CKYC Form.
- Policy copy
- Claim Intimation letter
- Confirmation of coverage letter
- FIR – Attested or Original.
- Final Police Report / Original Panchnama
- KYC Documents of Insured & Payee (Photo Identity Proof - Voter ID, Passport, PAN Card, Driving License, Ration Card, Aadhar card, or any other proof accepted by the KYC norms as approved by Us and which is admissible in court of law).
- NEFT Documents of Payee/Nominee (Printed copy of Passbook Copy / Cancelled cheque copy)
-
Loss wise list of documents required (in addition to above mentioned documents):
-
List of Documents for Accidental Death Claim:
- Death Certificate
- Post-mortem report
- Inquest/Coroner’s Report
- Legal Heir certificate /nominee certificate.
- Any other document pertaining to the claim as requested by claim settling authority.
-
List of Documents for Temporary Total Disability (TTD) Claim
- Certificate of from government hospital doctor confirming the nature and degree of disability.
- Discharge summary of the treating hospital clearly indicating the Hospital Registration No
- Diagnostic reports.
- Leave certificate.
- Any other document pertaining to the claim as requested by claim settling authority
-
List of Documents for Permanent Total Disability (PTD) Claim
- Certificate of from government hospital doctor confirming the nature and degree of disability.
- Discharge summary of the treating hospital clearly indicating the Hospital Registration No
- Diagnostic reports.
- Photograph of the injured with reflecting disablement
- Termination letter for claim under “Loss of Employment”.
- Any other document pertaining to the claim as requested by claim settling authority
-
List of Documents for Permanent Partial Disability (PPD) Claim
- Certificate of from government hospital doctor confirming the nature and degree of disability.
- Discharge summary of the treating hospital clearly indicating the Hospital Registration No
- Diagnostic reports.
- Photograph of the injured with reflecting disablement
- Any other document pertaining to the claim as requested by claim settling authority
-
List of Documents for Medical Expenses (ME) Claim
- Discharge card/certificate/ death certificate in original
- Itemized hospital bill in original
- Hospital and related medical expensed receipt with revenue stamp in original
- Copies of prescription for diagnostic test, treatment advise, medical references etc
- Details of the implants including the sticker indicating the type as well as invoice towards the cost of implant
- Hospital registration number/ the number of beds available with the hospital verified by the authorized signatory of the Hospital
- Any other document pertaining to the claim as requested by claim settling authority.
-
-
Generic Documents for all claims
(Accidental Death, Permanent Total Disability & Critical Illness)
- Duly filled original Claim Form along with duly filled Bank Mandate Form & CKYC Form.
- Policy copy
- Claim Intimation
- FIR – Attested or Original.
- Final Police Report / Original Panchnama
- KYC Documents of Insured & Payee (Photo Identity Proof - Voter ID, Passport, PAN Card, Driving License, Ration Card, Aadhar card, or any other proof accepted by the KYC norms as approved by Us and which is admissible in court of law).
- NEFT Documents of Payee/Nominee (Printed copy of Passbook Copy / Cancelled cheque copy)
-
Loss wise list of documents required in addition to above mentioned documents:
List of Documents for Permanent Total Disability (PTD) Claim:
- Certificate of from government hospital doctor confirming the nature and degree of disability
- Discharge summary of the treating hospital clearly indicating the Hospital Registration No.
- Diagnostic reports
- Confirmation of coverage letter
- Photograph of the injured with reflecting disablement
- Certificate from the Bank/ Financial Institution Stating the amortization schedule, the EMI Amounts, Principal Outstanding.
- Any other document pertaining to the claim as requested by claim settling authority.
List of Documents for Critical Illness Claim:
- Death Certificate
- Attested copy of Form IV confirming the cause of Death.
- All Hospital documents with 1st treatment paper, Indoor case paper, Casualty note & Death / Discharge summary.
- Treatment papers confirming the duration of Aliment.
- Certification from Doctor confirming the Critical Illness / Cause of Death
- Certificate from the Bank/ Financial Institution Stating the amortization schedule, the EMI Amounts, Principal Outstanding.
- Any other document pertaining to the claim as requested by claim settling authority.
-
Generic Documents for all claims (Accidental Death, Permanent Total Disability & Critical Illness)
- Duly filled original Claim Form along with duly filled Bank Mandate Form & CKYC Form.
- Policy copy
- Claim Intimation
- FIR – Attested or Original.
- Final Police Report / Original Panchnama
- KYC Documents of Insured & Payee (Photo Identity Proof - Voter ID, Passport, PAN Card, Driving License, Ration Card, Aadhar card, or any other proof accepted by the KYC norms as approved by Us and which is admissible in court of law).
- NEFT Documents of Payee/Nominee (Printed copy of Passbook Copy / Cancelled cheque copy)
-
Loss wise list of documents required in addition to above mentioned documents:
List of Documents for Accidental Death Claim:
- Death Certificate
- Post-mortem report.
- Inquest/Coroner’s Report
- Legal Heir certificate /nominee certificate.
- Confirmation of coverage letter.
- Certificate from the Bank/ Financial Institution Stating the amortization schedule, the EMI Amounts, Principal Outstanding.
- Any other document pertaining to the claim as requested by claim settling authority.
-
List of Documents for Permanent Total Disability (PTD) Claim:
- Certificate of from government hospital doctor confirming the nature and degree of disability
- Discharge summary of the treating hospital clearly indicating the Hospital Registration No.
- Diagnostic reports
- Confirmation of coverage letter
- Photograph of the injured with reflecting disablement
- Certificate from the Bank/ Financial Institution Stating the amortization schedule, the EMI Amounts, Principal Outstanding.
- Any other document pertaining to the claim as requested by claim settling authority.
-
List of Documents for Critical Illness Claim
- Death Certificate
- Post-mortem report.
- Inquest/Coroner’s Report
- Legal Heir certificate /nominee certificate.
- Confirmation of coverage letter.
- Certificate from the Bank/ Financial Institution Stating the amortization schedule, the EMI Amounts, Principal Outstanding.
- Any other document pertaining to the claim as requested by claim settling authority.
Process Flow
Turn Around Time (TAT)
Process Flow
Turn Around Time (TAT)
Motor Claim Process
-
Claim Form
-
Original Vehicle Registration Certificate
-
OR duly filled and signed Form26 by Insured triplicate copies,
-
Driving License of last driver of vehicle
-
Vehicle Particular Blacklist /Stolen/ No use status update by concern RTO
-
OR Acknowledgment receipt by concern RTO about Vehicle Stolen / No Use / To Be blacklist
-
Original Sale Invoice in case of First Owner,
-
Sale / Purchase Deed in case other than first owner
-
In case of 2nd owner without Hypothecation then may require ITR copy.
-
Previous Policy verification
-
Insured Statement about theft
-
Last user statement about theft with Identity Proof
-
Police FIR / Final Chargesheet.
-
Duly filled and signed Form28 by Insured triplicate copies
-
All Key Set
-
If Lock set has been changed then Lock set changed bill
-
If Full Key set not available, then any intimation to concern Insurer / Police authority about Key Loss.
-
Service History or Any other documentary/ digital evidence like recent CCTV footage of vehicle which can show vehicle existence just before theft,
-
Honorable Court approved Final Untrace report,
-
Duly signed and Notarized Indemnity Bond,
-
Duly signed and Notarized Subrogation Letter,
-
Address Proof,
-
Identity Proof,
-
CKYC form,
-
Discharge Voucher,
-
Duly signed Neft Mandate form / Cancel CTS Cheque / Bank Passbook
For Passenger Car /Bus
Above documents plus following addition documents-
-
Permit Copy,
-
Authorization Copy,
-
Fitness Copy,
-
Road Tax Copy,
-
Passenger Details,
-
Trip Sheet
For Goods Carrying Vehicle
-
Above documents plus Load Challan / Builty except Passenger Details, Trip Sheet
-
Pls Note-Insured and Driver Google Timeline, Fast Tag Statement, Vehicle GPS / Blue link history as provided by OEM, Toll receipts will require to confirm Loss Place date, time
Additional Document for Hypothecated cases
-
Non repossession Letter by concern Financer,
-
Loan Account Statement,
-
NEFT details of Financer Loan Account,
-
Foreclosure Letter
If no Hypothecation Or after Loan Closer
-
Bank NOC and Form 35 duly stamped and signed by Financer
Please Note-Any other requirement on basis of merits of claim then insurer may ask for additional document if any
Visit our website www.universalsompo.com. For Intimation click on Motor Claim Intimation. Answer a few questions and the claim will be registered
Alternatively you call our toll free number and intimate the claim
Following information needs to be furnished by you while intimating a claim:
-
Your Contact Numbers
-
Policy Number
-
Name of Insured person
-
Date & Time of accident
-
Location of Loss
-
Brief description on how the accident took place
-
Extent of loss
-
Place & contact details of the Insured Person (in case person intimating the claim is other than the insured person
Driver Name
-
Intimate the claim through the various channels available for intimation.
-
Get the spot survey done in case the vehicle is Goods carrying or passenger carrying. In case of PVT vehicle if possible, take photograph at the spot along with the details of other vehicle involved.
-
Submit duly filled and signed claim form. Please mention the correct cause of loss.
-
Loss falling within the definition of named peril in the policy will be covered for any insurance claim.
-
Furnish all information and documentary evidence as required.
-
It is recommended to submit an estimate of repair to ascertain the cost of parts which keeps on changing. In absence of the same the surveyor can prepare an estimate as per the last available price.
-
We will appoint a surveyor immediately after receipt of intimation to assess the loss as per IRDAI guidelines.
-
The surveyor shall inspect the damaged vehicle, discuss the cost of repair or replacement with the repairers and submits his report to the insurance company having assessment as below criteria
- If repairing carried with replacement of OEM Parts by Insured (Original Equipment as Supply by Manufacturer)-Assessment will be as per actual Rate with actual depreciation
- If repairing carried with replacement of OES Parts by Insured (Original Equipment supplier)- Assessment will be 30% less on OEM part rate after applying applicable depreciation
- If repairing carried with replacement of Non-OEM / Non OES Parts by Insured- Assessment will be 50% less on OEM part rate without applying the applicable depreciation.
- In case of theft, immediately inform the police authorities and Insurance company as well :
-
Insurer decides the admissibility of claim after
- verifying 64vb Clause-Verifying Premium Receipt at insurer end. When a Payment is made through cheque or online mode there is a possibility of return due to various factors including server errors. If the Premium is not received in advance the policy becomes void. The same is checked by system validation
- Cause of Loss and the sustained damages will be evaluated by the appointed surveyor which will be verified further by Technical Team of Insurer. In case of any mismatch in the same for particular damage or damage in entirety can be denied.
- Insurable Interest- The property insured and the policy needs to be in the same name and the physical position of the vehicle should remain with the registered owner. However, if physical ownership is changed by entering into some agreement or by transfer where policy is not transferred it is treated as breach of Insurable interest. And the claim can be denied if it breaches the timelines of 15 days from any such transfer of vehicle.
- Verifying All relevant document Validity w.r.t Loss date and Loss Time,
- Verifying damages with Pre-inspection photos and Previous claim if any, same will be allowed only for fresh damages and not repeated / old / pre existing. It can be a pro rata settlement as there are existing damages present in the same panel based on indemnity principle.
- Verifying validity of Previous policy- Claim will be allow if Previous policy details found valid as per previous insurer records
- NCB verification- If no claim is made in previous policy / policies preceding previous year. Bonus in terms of discount is provided based on the number of years no claim has been preferred. If any misrepresentation on NCB is made in terms of eligible slab of NCB. The % misrepresented plus 10% will be deducted from claim amount.
- Delay intimation which leads to deterioration of Vehicle then excluded the same from assessment.
- In Case of any discrepancy the claim may be referred for fact finding / forensic analysis / accident reconstruction etc.
- If you have paid the repair bill directly to the repairer, then get the bill in the name of Universal Sompo GIC Ltd. With proper GSTIN number available with all the offices. You can reimburse with the amount on submission of a receipt/bill from the repairer.
- Wherever possible click spot photos of vehicle after accident with photos of other involved vehicles etc.
- Vehicle will be declared Constructive Total Loss where the aggregate cost of repairs exceeds 75% of IDV mentioned in the Policy. If the vehicle has not suffered extensive structural damage and can be repaired using reconditioned / OES Parts without affecting the structural integrity of the vehicle the same can be sold with RC and if the structural integrity is compromised the same should be sold without RC The vehicle can be retained by Insured by opting for cash loss settlement where wreck value will be deducted from the IDV and rest amount will be paid after deduction of compulsory excess.
- The company may offer replacement of same Make and Model in case the model is discontinued OR The vehicle ownership sequence is greater than one
- The CTL will be decided based on the safety parameters which includes structural panel, crumple zones safety equipment fitted in the vehicle, water contamination due to inundation. Any deviation in the same by opting for substandard repairs will not be considered for determination of the liability.
- No Salvage will be deducted for any claim however, Salvage can be collected by authorized vendor or USGI officials.
• Precaution to be taken with vehicle
-
The vehicle should not be left unattended without proper precautions taken to prevent further loss or damage.
- Don’t drive the vehicle before the necessary repairs are affected, as any extension of the damage or any further damage is not payable under the policy.
- While parking engage the Handbrake properly and put the vehicle in Gear if the vehicle is having Manual Transmission or P if the vehicle is having Automatic transmission. Or Park the vehicle always as mentioned in Owner’s Manual provided by Manufacturer
- In case you see the water, level is more than 4 inches avoid driving the vehicle through it. Please follow the safe water level for driving as per owner’s Manual.
- Maintain the vehicle in roadworthy condition, replace brake Pads/Shoes before it reaches the limit, Change oils as prescribed.
- Carry out periodic maintenance as recommended by the OEM.
- If the vehicle stops in water do not start the vehicle or try to jump start or push start the same without professional guidance. Pls note water needs to be taken out through spark plug, or injectors depending on fuel type and no rotation of engine should be done before the said repairs.
- In case of vehicle being declared CTL / TL/ NOS the same can be shifted to a safe custody till further process.
- Keep the keys including the duplicate in safe custody as keys are also having immobiliser facility to evade theft. In case you loose the key , get the keys replaced and recoded. Any loss of key needs to be informed to the insurer immediately.
- Do not make duplicate keys as this may cause vulnerability of theft.
- Do not leave duplicate keys with the vehicle.
- Do not change the seating capacity or carry any alternation / modification in contravention to MV act/ rules.
Turn Around Times
| Description | Turn Around Time |
|---|---|
| Surveyor appointment | within 24hrs from Claim Intimation |
| Survey Completion | within 24hrs of Surveyor appointment |
| Surveyor report submission | within 15 days from Date of Survey |
| Settlement / Claim decision | within 7 days from date of receipt of surveyor report |
| Claim Payment to Insured in case of NonCashless | 30 days from the receipt of Last Document |
-
Give immediate written notice to the insurance company about an accident to third party.
-
Furnish all information and documentary evidence as the insurance company may require.
-
As soon as the insurance company receives intimation about the third party claim, investigation is carried out about the accident.
-
To collect the relevant data with the objective to quantify reasonable and just compensation, a trained investigator is appointed by the insurance company.
-
At the same time you should be submit claim form along with relevant documents.
-
On receipt of intimation form Court or MACT, a competent Advocate from the panel may be appointed.
Name of the company: Universal Sompo General Insurance Company Limited
Registered & Corporate Office: Office No. 103, 1st Floor, Ackruti Star, MIDC Central Road, Andheri (East), Mumbai 400093, Maharashtra. Tel: 02241659800/ 900
Website: www.universalsompo.com.
E-mail: contactus@universalsompo.com
Customer Service: Toll Free Numbers: 1800 22 4030 / 1800 200 4030
Note: Please note that above is the gist. Please read the policy wordings in detail
|
Sr No |
Products |
Final UINs with revisons |
|
1 |
Motor Private Car |
IRDAN134RP0004V02200708 |
|
2 |
Motor Two Wheeler Insurance |
IRDAN134RP0007V02200809 |
|
3 |
Motor Passenger Carrying Vehicle |
IRDAN134RP0008V02200809 |
|
4 |
Motor Goods Carrying Vehicle |
IRDAN134RP0009V02200809 |
|
5 |
Motor Misc. Vehicle |
IRDAN134RP0010V02200809 |
|
6 |
Motor Trade Insurance Policy |
IRDAN134RP0028V02200809 |
|
7 |
Third Party Long Term Two Wheeler Insurance Policy |
IRDAN134RP0047V01201415 |
|
8 |
Two Wheeler Long Term Package Policy (TWLTPP) |
IRDAN134RP0007V02201617 |
|
9 |
Motor Private Car - Bundled |
IRDAN134RP0001V02201819 |
|
10 |
Motor Two Wheeler - Bundled |
IRDAN134RP0002V02201819 |
|
11 |
Third Party Private Car Policy - 3 Years |
IRDAN134RP0005V01201819 |
|
12 |
Third Party Two Wheeler Policy - 5 Years |
IRDAN134RP0006V02201819 |
|
13 |
Compulsory Personal Accident (Owner-Driver) under Motor Insurance Policies |
IRDAN134RP0067V02201819 |
|
14 |
Stand-Alone Motor Own Damage Policy - Private Car |
IRDAN134RP0001V01201920 |
|
15 |
Stand-Alone Motor Own Damage Policy - Two Wheeler |
IRDAN134RP0002V01201920 |
|
16 |
Standalone Motor Third Party Insurance – Two Wheeler |
IRDAN134RP0001V01202122 |
|
17 |
Standalone Motor Third Party Insurance - Goods Carrying Vehicle |
IRDAN134RP0002V01202122 |
|
18 |
Standalone Motor Third Party Insurance - Passenger Carrying Vehicle |
IRDAN134RP0003V01202122 |
|
19 |
Standalone Motor Third Party Insurance – Miscellaneous Vehicle |
IRDAN134RP0004V01202122 |
|
20 |
Standalone Motor Third Party Insurance - Private Car |
IRDAN134RP0005V01202122 |
Note: Please note that above is a gist, please read the policy wordings in detail
Commercial Claim Process
In event of any claim arising in case of any contingency/ happening of loss, please intimate immediately to
- Nearest USGICL Branch office
- On our call centre number or on toll free number 1-800-22-4030 (from MTNL & BSNL Lines), or
- Write to us on contactus@universalsompo.com | contactclaims@universalsompo.com
Details of our offices can be found in the USGICL Office Locator in our Website.
Following information needs to be furnished by you while intimating a claim:- Policy Number
- Insured Name
- Nature of Loss
- Date & Time of loss
- Loss description
- Location of loss
- Contact person on site (name, e-mail, phone no.)
- Details of damaged items
- Any damage to third party property
- Details/reports of the loss to any other authorities, if any (police/fire brigade, etc)
- Estimated loss amount
Fire Claim Process
As soon as a loss is noticed, please intimate immediately to our nearest office or on our call centre number or on toll free number 1-800-22-4030 (from MTNL & BSNL Lines.) Our claims officials shall soon get in touch with you and shall be happy to help you with the claim procedures. Details of our offices can be found in the USGICL Office locator.
Following information needs to be furnished by you while intimating a claim:
- Your Contact Numbers
- Policy Number
- Name of Insured person,
- Date & Time of accident,
- Location of Loss,
- Brief description on how the accident took place,
- Extent of loss
- Place & contact details of the Insured Person (in case person intimating the claim is other than the insured person.
- Take measures to extinguish the fire and all steps to minimize the extent of loss.
- Inform the Fire Brigade and co-operate with them but don't forget to obtain the Fire Brigade Report and bill for firefighting expenses, because these expenses are payable under the policy.
- Intimate the insurance company with a rough estimate of loss as early as possible and obtain your claim form, within 14 days of the loss.
- In case of damage due to natural calamities like storm, floods, lightning, obtain the meteorological report for the weather broadcast at the time of disaster.
- Do not dispose the Salvage until advised by the surveyor or Insurance Company.
- Claim Form duly filled in & signed.
- Claim bills: Detailed claim bills with necessary bills/vouchers.
- F.I.R, if filed.
- Fire Brigade Report (internal or external or both as the case may be).
- Forensic Departments report, if applicable.
- Laboratory test report together with the mandate given, if applicable.
- Record of Labour involved in activities related to claim.
- Original Repair/ Replacement Bills with receipt.
- Photographs if arranged.
- Departmental Note on the incident.
- Meteorological report: In case of natural calamities like floods, cyclone, earthquake etc) or News paper cutting.
- Take measures to extinguish the fire and all steps to minimize the extent of loss.
- Inform the Fire Brigade and co-operate with them but don't forget to obtain the Fire Brigade Report and bill for firefighting expenses, because these expenses are payable under the policy.
- Intimate the insurance company with a rough estimate of loss as early as possible and obtain your claim form, within 14 days of the loss.
- In case of damage due to natural calamities like storm, floods, lightning, obtain the meteorological report for the weather broadcast at the time of disaster.
- Do not dispose the Salvage until advised by the surveyor or Insurance Company.
- Claim Form duly filled in & signed.
- Claim bills: Detailed claim bills with necessary bills/vouchers.
- F.I.R, if filed.
- Fire Brigade Report (internal or external or both as the case may be).
- Forensic Departments report, if applicable.
- Laboratory test report together with the mandate given, if applicable.
- Record of Labour involved in activities related to claim.
- Original Repair/ Replacement Bills with receipt.
- Photographs if arranged.
- Departmental Note on the incident.
- Meteorological report: In case of natural calamities like floods, cyclone, earthquake etc) or News paper cutting.
Engineering Claim Process
As soon as a loss is noticed, please intimate immediately to our nearest office or on our call centre number or on toll free number 1-800-22-4030 (from MTNL & BSNL Lines.) Our claims officials shall soon get in touch with you and shall be happy to help you with the claim procedures. Details of our offices can be found in the USGICL Office locator.
Following information needs to be furnished by you while intimating a claim:
- Your Contact Numbers
- Policy Number
- Name of Insured person,
- Date & Time of accident,
- Location of Loss,
- Brief description on how the accident took place,
- Extent of loss
- Place & contact details of the Insured Person (in case person intimating the claim is other than the insured person.
- Ensure that all the steps have been taken to minimize the extent of loss or damage.
- In case of loss or damage by fire, inform the Fire Brigade and co-operate with them but don't forget to;
- Obtain Fire Brigade Report and bill for fire fighting expenses, because these expenses are payable under the policy.
- Intimate the insurance company with a rough estimate of loss as early as possible.
- The insurance company will not be liable for any loss or damage, if the same is not intimated to them within 14 days.
- In case of damage due to natural calamities like storm, floods, lightning, obtain the meteorological report for the weather broadcast at the time of disaster.
- Furnish all information and documentary evidence as the insurance company may require.
- In case of loss or damage due to theft or burglary, inform the police authorities.
- You may proceed with the repair of any minor damage not exceeding Rs 5000/-. If damages exceed Rs 5000/-, a representative of the insurance company shall inspect the loss or damage before any repairs or alternations are effected.
- Preserve the parts affected and make them available for inspection by a representative or surveyor appointed by the insurance company.
- The Salvage materials should be disposed off at best available prices which will help in minimizing your loss to a certain extent.
- In case of loss or damage to third party, you may forward immediately any notice of claim received from a third party without admitting liability. You should not offer, admit, compromise or promise any payment to third party without the consent of the insurance company in writing.
- Erection All Risk Insurance
- Contractors All Risks Insurance
- Machinery Loss of Profits Insurance Policy
- Marine Cum Erection All Risks Insurance Policy
- Boiler & Pressure Vessel Insurance Policy
- Electronic Equipment Insurance Policy
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Erection All Risk Insurance
- Claim form duly filled and signed
- Original Repair Bills with receipt.
- The amount of loss: Detailed claim bills with necessary bills/vouchers like bill for repairs/ replacement/ original invoice/ bill of entry.
- Photographs if arranged Fire Brigade Report
- Repair agency's report detailing their findings on Cause and the repair procedure suggested
- Departmental Note on incident and repairs to be undertaken
- Specification of Repair form filled by the repairer
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Contractors All Risks Insurance
- Claim Form duly filled in & signed.
- Record of Labour involved in activities related to claim.
- Inventory of Loss.
- Abstract of relevant portion of Running Account Bill
- Original Repair Bills with receipt.
- Photographs if arranged.
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Machinery Loss of Profits Insurance Policy
- Claim Form duly filled in & signed.
- Books of Accounts.
- Record of Labour involved in activities related to claim.
- Details of Savings affected in Standing Charges.
- Claim Bill.
- Details of Increased Cost of Working.
- Details of Trends of Business.
-
Marine cum Erection All Risks Insurance Policy
- Claim Form duly filled in & signed.
- Record of Labour involved in activities related to claim.
- Inventory of Loss.
- Original Repair Bills with receipt.
- Photographs if arranged.
- Makers report detailing Extent of Loss, Cause and suggested repair procedure.
-
Boiler & Pressure Vessel Insurance Policy
- Claim Form duly filled in & signed.
- Original Repair Bills with receipt.
- Details of Third party Claims.
- Photographs if arranged.
- Boiler Inspectorate's report.
-
Electronic Equipment Insurance Policy
- Claim Form duly filled in & signed.
- Original Repair Bills with receipt.
- Photographs if arranged.
- AMC/Repair agency's report detailing Extent of damage, Cause and suggested repair procedure.
- Report filed by the AMC in the visit immediately preceding the Loss Date.
Marine Claim Process
As soon as a loss is noticed, please intimate immediately to our nearest office or on our call centre number or on toll free number 1-800-22-4030 (from MTNL & BSNL Lines) for inland transit claims or to our Overseas worldwide Claims Settling Agent, W.K. Webster & Co. Ltd. by electronic notification of loss on their website www.wkwebster.com / "report new claim". Our claims officials shall soon get in touch with you and shall be happy to help you with the claim procedures. Details of our offices can be found in the USGICL Office locator.
Following information needs to be furnished by you while intimating a claim:
- Your contact numbers and complete address of the location where the damaged cargo is available for inspection
- Policy number and name of insured
- Date & time of accident, if any
- Brief description of nature of loss and estimated extent of loss
- In case of damage/accident, please do not disturb the packages or accident site till a survey is held.
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Please ensure that all the rights of recovery against carriers, bailees or other third parties are preserved and exercised in the prescribed time limits, as under, so as not to prejudice admissibility of any valid claim :
STATUTORY TIME LIMITS FOR NOTIFICATION / CLAIM TO BE FILED AGAINST CARRIERS / CUSTODIANSMODE FIRST NOTIFICATION, WITHIN FORMAL MONETARY CLAIM, WITHIN TIME BAR Road 7 days from delivery 6 months from LR date 3 years from LR date Railways 7 days from delivery 6 months from LR date 3 years from LR date Air 7 days for damage and 14 days for Non Delivery Formal monetary claim on Carrier / Custodian should be filed immediately on final quantification of loss. 3 years from LR date Ocean 3 days from discharge of break bulk or receipt of delivery order for containerized cargoes 1 year from B/L date 1 year from B/L date 1 year from B/L date 2 year from B/L date 1 year from B/L date Ports 7 days from discharge 6 months from discharge Postal 1 month from booking for damage and 3 months for Non Delivery 3 years from booking - In case of carriage by sea, while sending the first notification, you are required to request for a joint survey by the Shipping Company (ship survey) jointly with the Insurance survey. Please remember that if the survey is time barred by the shipping company, your claim could stand prejudiced.
- Obtain damage certificate/open delivery certificate/landing remarks certificate from carriers/ port trust/ airlines/ transporter etc.
- In case of damage due to natural calamities like storm, floods, lightning, obtain the meteorological report for the weather broadcast at the time of disaster.
- Do not dispose the damaged property until advised by the surveyor or Insurance Company.
- Original Insurance Policy / Certificate.
- Original negotiable Bill of Lading with terms printed on the reverse, Airway Bill or Inland Transport Receipt
- Original Commercial Invoice from Suppliers with copy of Packing / Weight List.
- Claim Form duly filled in and signed.
- Claim Bill on your letter head showing the amount of claim.
- Copy of Claim Notice served on Carrier/Custodians along with postal receipt and acknowledgement card.
- Copy of formal claim on the Carrier/Custodians.
- Original Repair Bills with receipt/Performa Invoice for value of items damaged / lost.
- Copies of correspondence exchanged with suppliers (reply from suppliers is a must) for short packing (if applicable).
- Letter of Subrogation cum special power of Attorney.
- Discharge Voucher.
- Original Insurance Policy / Certificate.
- Original negotiable Bill of Lading with terms printed on the reverse, Airway Bill or Inland Transport Receipt
- Original Commercial Invoice from Suppliers with copy of Packing / Weight List.
- Claim Form duly filled in and signed.
- Claim Bill on your letter head showing the amount of claim.
- Copy of Claim Notice served on Carrier/Custodians along with postal receipt and acknowledgement card.
- Copy of formal claim on the Carrier/Custodians.
- Original Repair Bills with receipt/Performa Invoice for value of items damaged / lost.
- Copies of correspondence exchanged with suppliers (reply from suppliers is a must) for short packing (if applicable).
- Letter of Subrogation cum special power of Attorney.
- Discharge Voucher.
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OCEAN TRANSIT
- Short Landing Certificate /Non-Delivery Certificate/Landing Remarks Certificate (as applicable).
- Quadruplicate copy of Duty Paid Bill of Entry (that is with TR-6 challan).
- Steamer Survey report in original
- Lost Overboard Certificate from the Port Trust countersigned by the master of the vessel or steamer agents (in respect of Loss over Board /Sling Losses).
- Note of Protest and Mate's Receipt in case the vessel had encountered heavy weather enroute, if applicable.
- Copy of application filed with Customs for refund of Duty (if applicable).
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AIR TRANSIT
- Original Landing Remarks Certificate (for damage claims)
- Original Non Delivery Certificate (for Non Delivery Claims)
- Original Short Delivery Certificate (for Short Delivery Claims)
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INLAND TRANSIT (RAIL)
- Open delivery Certificate or copy of application for open delivery, reply received from the Railways refusing open delivery, copy of the letter of protest sent to Railways with the acknowledgement thereto and certified extract of the remarks made in the station delivery or complaints book.
- Original Non Delivery Certificate (for Non Delivery Claims)
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INLAND TRANSIT (ROAD)
- Original Open delivery / Damage certificate or copy of notice given to carriers advising about survey, protest made to them (for Packages delivered apparently in damaged condition).
- Original Non Delivery Certificate (for Non Delivery Claims)
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POSTAL TRANSITS
- Original Non Delivery Certificate (for Non Delivery Claims)
- Original Short Delivery Certificate (for Short Delivery Claims)
- Original certificate of damage / loss issued by the postal authorities (for Damage Claims).
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FOR CLAIMS UNDER DUTY AND INCREASED VALUE POLICIES (IMPORTS)
- Customs Examination Certificate.
- Cargo insurer's claim settlement letter.
- Customs Duty Refund Application.
- Acknowledgement for Customs Duty Refund.
- Proof of Market value (increased value claim).
Miscellaneous Claim Process
As soon as a loss is noticed, please intimate immediately to our nearest office or on our call centre number or on toll free number 1-800-22-4030 (from MTNL & BSNL Lines.) Our claims officials shall soon get in touch with you and shall be happy to help you with the claim procedures. Details of our offices can be found in the USGICL Office locator.
Following information needs to be furnished by you while intimating a claim:
- Your Contact Numbers
- Policy Number
- Name of Insured person,
- Date & Time of accident,
- Location of Loss,
- Brief description on how the accident took place,
- Extent of loss
- Place & contact details of the Insured Person (in case person intimating the claim is other than the insured person.
Rural Claim Process
As soon as a loss is noticed, please intimate immediately to our nearest office or on our call centre number or on toll free number 1-800-22-4030 (from MTNL & BSNL Lines.) Our claims officials shall soon get in touch with you and shall be happy to help you with the claim procedures. Details of our offices can be found in the USGICL Office locator.
Following information needs to be furnished by you while intimating a claim:
- Your Contact Numbers
- Policy Number
- Name of Insured person,
- Date & Time of loss,
- Location of Loss,
- Brief description on cause of loss,
- Place & contact details of the Insured Person (in case person intimating the claim is other than the insured person.
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CATTLE/ LIVESTOCK INSURANCE:
- Claim Form filled by the Insured
- PM Report issued by the Veterinary Doctor
- Photographs of the Dead Animal and Ear with Ear-tag.
- Intact Ear-Tag removed from the Ear.
- Health Certificate issued by Veterinary Doctor during tagging.
- FARMER'S PACKAGE INSURANCE:
-
armers Package Policy has the following Sections
- Fire section
- Burglary section
- Agricultural Pump set
- Animal Driven Cart
- Cattle
- Janta Personal Accident
- Bio Gas Plant
- Agriculture Tractor
Track Claims
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Crop Insurance Claim
| Sr.No | TPA Name | TPA Registration No. | Product Name | Location | TPA Website Link |
|---|---|---|---|---|---|
| 1 | Health India Insurance TPA Services Private Limited | 022 | Group Health Insurance | Pan India | www.healthindiatpa.com |
| 2 | Vidal Health Insurance TPA Private Limited | 016 | Group Health Insurance | Pan India | www.vidalhealthtpa.com |
| 3 | Paramount Health Insurance Services & Insurance TPA Private Limited | 006 | Group Health Insurance | Pan India | www.paramounttpa.com |
| 4 | Ericson Insurance TPA Private Limited | 035 | Group Health Insurance | Pan India | www.ericsontpa.com |
| 5 | Family Health Plan Insurance TPA Limited | 013 | Group Health Insurance | Pan India | www.fhpl.net |
| 6 | MD India Health Insurance TPA Private Limited | 005 | Group Health Insurance | Pan India | www.mdindiaonline.com |
| 7 | Genins India Insurance TPA Private Limited | 020 | Group Health Insurance | Pan India | www.geninsindia.com |
| 8 | Volo Health Insurance TPA Private Limited | 018 | Group Health Insurance | Pan India | www.eastwestassist.com/home/volohealth |
| 9 | Medi Assist Insurance TPA Private Limited | 003 | Group Health Insurance | Pan India | www.mediassisttpa.in |
| 10 | Link-K Insurance TPA Private Limited | 038 | Group Health Insurance | Pan India | www.linkktpa.com |
Rates for Covid -19 Treatment
Roles, Duties and Responsibilities of Surveyors
It shall be the duty of every Licensed Surveyor and Loss Assessor to investigate, manage, quantify, validate and deal with losses (whether insured or not) arising from any contingency, and report thereon to the insurer or insured, as the case may be., All Licensed Surveyors and Loss Assessors shall carry out the said work with competence, objectivity and professional integrity and strictly adhere to the code of conduct as stipulated in these Regulations.
- The following, shall, inter alia, be the duties and responsibilities of a Surveyor and Loss Assessor:
- declaring whether he has any interest in the subject-matter in question or whether it pertains to any of his relatives, business partners or through material shareholding; Explanation: For the purpose of this clause ‘relatives’ shall mean any of the relatives as defined in Subsection (77) of Section 2 of the Companies Act, 2013;
- Bringing to the notice of the Authority, any change in the information or particulars furnished at the time of issuance of license, within a period not exceeding fifteen days from the date of occurrence of such change, that has a bearing on the license granted by the Authority
- maintaining confidentiality and neutrality without jeopardising the liability of the insurer and claim of the insured;
- conducting inspection and re-inspection of the property in question suffering a loss.
- examining, inquiring, investigating, verifying and checking upon the causes and the circumstances of the loss in question including extent of loss, nature of ownership and insurable interest.
- conducting spot and final surveys, as and when necessary and comment upon franchise, excess/under insurance and any other related matter.
- estimating, measuring and determining the quantum and description of the subject under loss.
- advising the insurer and the insured about loss minimisation, loss control, security and safety measures, wherever appropriate, to avoid further losses;
- commenting on the admissibility of the loss as also observance of warranty conditions under the policy contract;
- surveying and assessing the loss on behalf of insurer or insured;
- assessing liability under the contract of insurance; l. pointing out discrepancy, if any, in the policy wordings;
- satisfying queries of the insured/insurer and of persons connected thereto in respect of the claim/loss;
- recommending applicability of depreciation, percentage and quantum of depreciation;
- giving reasons for repudiation of claim, in case the claim is not covered by policy terms and conditions;
- taking expert opinion, wherever required;
- commenting on salvage and its disposal wherever necessary.
- A surveyor or loss assessor whether appointed by insurer or insured, shall submit his report to the insurer as expeditiously as possible, but not later than 30 days of his appointment, with a copy of the report to the insured giving his comments on the insured’s consent or otherwise on the assessment of loss. Where, in special circumstances of the case, either due to its special and complicated nature, the surveyor shall under intimation to the insured, seek an extension, in any case not exceeding six months from the insurer for submission of his report.
- In cases where the Survey report is pending due to non-completion of documents, the surveyor may issue the final survey report independently based on the available documents on record, giving minimum three reminders in writing to the insured.
- If an insurer, on the receipt of a survey report, finds that it is incomplete in any respect, he shall require the surveyor under intimation to the insured, to furnish an additional report on such incomplete issues. Such a request may be made by the insurer within 15 days of the receipt of the original survey report. Provided that the facility of calling for an additional report by the insurer shall not be resorted to more than once in the case of a claim.
- The surveyor on receipt of this communication shall furnish an additional report within three weeks of the date of receipt of communication from the insurer.