Page 259 - IC38 GENERAL INSURANCE

5. Claim form

Claim form is the formal and legal request for processing the claim and is
submitted in original signed by the customer. The claim form has now been
standardized by IRDAI and broadly consists of:

a) Details of the primary insured and the policy number under which the
claim is made.

b) Details of the insurance history

c) Details of the insured person hospitalized.

d) Details of the hospitalization such as hospital, room category, date and
time of admission and discharge, whether reported to police in case of
accident, system of medicine etc.

e) Details of the claim for which the hospitalization was done including
breakdown of the costs, pre and post-hospitalization period, details of
lump-sum/cash benefit claimed etc.

f) Details of bills enclosed

g) Details of bank account of primary insured for remittance of sanctioned
claim

h) Declaration from the insured.

Besides information on disease, treatment etc., the declaration from the
insured person makes the claim form the most important document in the legal
sense.

It is this declaration which applies the “doctrine of utmost good faith” into the
claim, breach of which attracts the misrepresentation clause under the policy.

6. Identity proof

With the increasing use of identity proof across various activities in our life, the
general proof of identity serves an important purpose – that of verifying
whether the person covered and the person treated are one and the same.

Usually identification document which is sought could be:

a) Voters identity card,

b) Driving license,

c) PAN card,

d) Aadhaar card etc.

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