MOTOR CLAIM PROCEDURES

MOTOR CLAIMS:

  1. Call or visit our office or any of our Agent’s Office to report an accident.

These will be documents to be submitted to the insurance representative:

  • Claim Form – Every claim must be accompanied by a claim form.  The claims clerk/handler must ensure that the claim form is correctly completed and all relevant fields entered. The claim form is also to include all third parties/property damage that the Insured would have come into contact with.   This information is needed to establish the validity of a claim (Refer to Appendix 1 – Insured Claim Form).
  • Drivers Permit – Every claim form must be accompanied by a valid driver’s permit, the driver’s permit received and the driver information submitted on the claim form must be the same.  In instances where the Driver is a visitor to the country both the international permit as well and the driver’s local permit has to be submitted.
  • Estimate – The estimate is the most important document in the claims process and this is needed to settle the client’s claim. The estimate must be on a Company’s letterhead and bear an official stamp and also include the name, address and contact number/s of the repairer.  The following information should be listed on the estimate.
    • The list of parts to be replaced.
    • The list of parts to be repaired.
    • The replacement cost of the parts.
    • The cost of labour to repair/replace the parts.
    •  The date the estimate was prepared.
  • Photographs – Once a claim is reported and the vehicle can be driven, photos of the vehicle must be taken, if possible, by the agent. Photos can also be accepted by the client if he has.

The following are guidelines for the taking of these photos.

    • The entire front of the vehicle ensuring that the number plate is visible.
    •  The entire area that is damaged on the vehicle.
    • The engine and if possible the chassis number of the vehicle.
    • Clear pictures of the damages, as much as possible focusing on the parts listed on the estimate.
  • Certificate of Title – These documents are necessary to confirm ownership of the vehicle. The claim is to be paid to the certified owner/s of the vehicle.
  1. Ensure to Protect Property from other damages.
  2. Contact information for both insured and third parties are to be recorded

Such as: telephone numbers, postal address and email address so that we can easily contact clients should further information be required.

Additional information

  • Statements – In instances where liability is not straightforward and statements are required, to assist in determining liability  these can be requested from the Insured, Third Parties, passengers of either vehicle or bystanders/onlookers. It is always advised that these statements be requested when the claim has just occurred and the information is fresh in the minds of the relevant parties.
  • Police Reports – Once there are major injuries stated on the claim form a Police Report is to be requested from the relevant authorities. These major injuries may be as a result of the following type of accidents:
    • Oncoming vehicles with head on impact
    • Actual or constructive total loss of the Insured or third Party vehicles
    • Moderate/substantial damage to the Insured’s vehicle with the involvement of a motorcyclist, cyclist or pedestrian
    • The presence of Police and ambulance services  at the scene of the accident
    • Several passengers in either the Insured or Third Party vehicles
    • Single vehicle accidents with several occupants (especially where occupants are not family members)
    • Minor claim notification (e.g. windscreen, damaged bumper and grill, fender) with third party involvement and only vague references to a third party vehicle, especially a pedestrian, a child, a cyclist etc. being involved.

SAGICOR HEALTH CLAIM PROCEDURES

SAGICOR HEALTH CLAIM GUIDELINES: 

Our goal is to process your claim within the 10 day turnaround time we have indicated to you.  In order for us to fulfil this goal, you can help us by ensuring that the following guidelines are followed:

THE CLAIM FORM

  1. Prepare a separate claim form for each family member.
  2. Complete ALL of the information requested with EACH claim submission.
  3. If you prefer that benefits be paid to the provider of services, be sure to complete the authorization for assignment of benefits section of the claim form.

THE PROVIDER BILLING OR RECEIPT

Each bill receipt should carry:

  1. The name, address, person or organization providing the service.
  2. The name of the patient receiving the service.
  3. The date of each service (a range of services cannot be accepted).
  4. The charge for each individual service.
  5. A description of each service.

On each bill, please delete any charges that were included on a previous claim. Personal itemizations, cash register receipts, credit card receipts and cancelled cheques are not acceptable. PLEASE NOTE THAT ORIGINAL RECEIPTS CANNOT BE RETURNED UNLESS ACCOMPANIED BY CLEAR COPIES.

Accidental Injury – Statements must contain details as to when, where and the manner in which the injury occurred as well as the name and address of the party at fault where applicable.

Prescription only drugs – Bills/receipts must include the prescription number, the name of the drug and the name of the physician prescribing the medication. (Please note that the cost of each drug must be indicated and receipts must carry the name/stamp of the pharmacy).

Private Duty Nursing – Bills/receipts must include the shift worked, the charge per hour, the number of hours worked, the nurse’s professional status, the family relationship to the patient if any. A statement from the attending physician explaining the necessity of this service and the authorization of the service should accompany the claim. 

Prosthetic appliances and the rental or purchase of durable equipment – A statement from the attending physician should accompany the claim. The statement should explain the medical necessity of the equipment and the physician’s authorization for it.

For patients covered by another insurance carrier – If the patient is claiming benefits for any charges that are eligible for benefits under any other health insurance policy, the explanation of benefits worksheet furnished by the other company pertaining to these expenses must be included with the itemized bills. A CLEAR copy of the other carrier’s explanation of benefits worksheet is acceptable in place of the original document.

Have you?

  • Fully completed and signed the claim form.
  • Attached all relating itemized bills/receipts.
  • Kept copies of documentation for your records.
  • Had your Plan administrator complete the employer’s section

Contact Info

2nd Floor of Habet’s Building,
Cor. Constitution Dr., Belmopan
Phone: +(501) 822-3585 | +(501) 822-3587
Mobile: +(501) 615-3587 | +(501) 607-6465
Email: info@siabz.com

Location

Guardian Group

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