\ ACCIDENT RELIEF CARE PVT. LTD. ap Ph: +91 80 40993666 /777 / 888, 9606666564 Wha gunn dost! E-mail : claims@accidentreliefcare.com H.0.: #2, nd Floor, Matadahalli Main Road B.0.: #11, (Design No, 38779), tst Floor, MLA layout, RT. Nagar, Bangalore - 560 032 Paramahamsa Road, Yadavagi, Mysore - $70 020 CLAIM PROCEDURE ‘Member /Relative /Friends can intimate about the claim within 48 hours from the date of accident Death claim should be intimated to ARC within 20 Days from the date of death. ‘To Register the claim : Contact or SMS to 9606666564, 8296161666, 080 - 40993666 / 777 / 888 / or you can write ustoclaims@accidentreliefcare.com along with Membership No. /ARC card No. 4 Cashless facility will be given only for INPATIENT (Hospitalization) claims minimum hospitalization of 24 Hours & claim has tobe registered inform within 24 Hours to avail the cashless Benefit ‘ The age of the member to be covered under this policy is between 5 to 65 years, and for renewal the upper age limitfor acceptance will be 75 years of age* 4 Allerintimation our PRO will visit the patient for verification within 48 hours* Outpatient treatment is payable up to 30 days only, from the date of accident, and 31st day of treatment will not be payable. Andthe sum assured for Outpatients 10,000/-per year ® Inpatient Treatment will be payable from the Date of admission to date of Discharge post follow ups, Implant removal will not be covered under this. policy andthe sum assured for Inpatientis 1,00,000)- per year ‘Outpatient claims will be settled within 7 working days from the date of documents submitted to ARC (subjected to submission of all required documents) % In-Patient claims will be settled within 35 days from the date of documents submitted to ARC (subjected to submission of all required documents) + Any treatment pertaining to Dental, Medical condition and treatment pertaining to Ligament tear partial Whole, Meniscal Tear partial ‘whole pertaining to knee not associated with fracture will not be covered.* 4 TreatmentRendered by a Registered Medical practitioner with minimum qualification of MBBS will only be entertained 4 Expenses pertaining to the treatment of trauma / Injury / Accidents will only be considered other supporting drugs like Vitamins, Calcium, and Proton Pump Inhibitors , Proteins supplementetc. Will notbe consider. Hospitalization Less than 24 hours forin-patient Treatmentis not payable ‘ In-Patient Bills to be submitted with the discharge summary to ARC within 15 Days from the date of Discharge, otherwise claim will not be considered and treated as No claim, Out Patient Bills to be submitted to ARC within 45 days from the date of Accident otherwise claim is Treated as No claim 4 Any Adventures games, intentional Self Injuries, Suicide or attempt to suicide, Assault, insanity or whilst under the influence of Intoxicating Drink or Drugs and alcohol, Racing. Body building Injuries, Mixed Marshal Art injuries, Boxing, Karate, injuries while Lifting the impossible weights is not covered under this Policy ‘The submitted documents will not be returned to patient or any other Individuals related to the patient once the claim is settled Allthe death related documents shouldbe submitted within 90 days. Snake bite, Dog bite, Insects bite treatment will be considered as only out patient. Incase of Reimbursement / Outstation claim patient has to submit the required documents. Allthe documents should be submitted in Original only ‘Second admission for Implant removal, Posthospitalization, follow ups are not covered under this policy. + ° eeeee OUTPATIENT DOCUMENTS CHECK LIST 4 Claim form and intimation to be filled and signed by the member, In case of injury to Right hand LTM and i Parents or the guardian can fill & sign the documents on behalf of the member. 4 Copy ofany Government ID prooflike Pan card /Aadhar card / Voter ID /Pass port/DL copy should be enclosed 4 Bank details ofthe Patient, Pass book frontpage copy / Cancelled Cheque leaf copy should be enclosed. literate‘ARC Membership card (copy) Medical Certificate from the treating doctor stating the history and line of treatment. Vaccination card with seal and signature of the doctor with qualification and Registration Number (In case of Dog bite) to be enclosed No bulk purchase of vaccine permitted .Vaccine should be purchased against prescription from the treating doctor and froma chemist X Ray Plates and reports should be enclosed, Pharmacy bills with prescription from the treating doctor to be enclosed, Lab reports, C.T. MRI. ‘Statement by the patient, History of injury took place to be enclosed, Letter for refund from company (In case policy in the name of company and the Approval amount tobe released in favor of patient) to be enclosed, All Claim related documents should be submitted original only ee eee ee * IN PATIENT (Hospitalization) 4 If RTA(Road Traffic Accident) MLC / FIR /Police intimation is mandatory (copy) + Ifincase of work place accident Required Letter from Company (Details of accident) 4 Blood Alcohol estimation Letter from The treating Doctor (Original ) 4 Detailed Discharge Summary (Original) Final In Patient Bill with break up (Original) + Cash paid receipt with hospital seal signature (Original) 4 Medicine bills with prescription (Original) X-Ray Reports Along with Films /Plates (Original), Lab Reports, ECG , MRI, CT Scan Reports tobe enclosed Implant Invoice (ifany Implants used) 4 Pre & Post-Operative X-Ray lms /Plates are mandatory 4 Indoor case papers (Admission Notes, Daily Doctor Notes, Nursing Chart & OT Notes with attestation from hospital ifany (Copy) IflisRTA(DL) copyis required 4 Any Govt Proof Like Aadhar card / Voter ID /Pan card / Passport Copy to be enclosed DEATH CLAIM CHECK LIST 4 Claim Form dul fled with details of Accident 4 Hospital records - Original i.e. Case Sheet - Death Summary / Discharge summary (if died in Hospital attested by Treating Doctor with seal & Signature (Original) Complaint Letter-attestedby police with seal 4 First Information Report (FIR), Panchnama / Inquest Report-attested by police with seal (Originals) 4 Post-Mortem Report —attested by Doctor / police with seal and sign (Originals) 4 Papercutting- Xerox, Colorphoto, spot photo of the accident favailable) Death Certificate by Panchayat/ Municipality ‘Corporation’Hospital if died in Hospital (Originals) 4 Final Investigation Report / Charge Sheet -Altested by S I (Originals) 4 Driving License /RC (ifthe deceasedis driving) 4 Details of the Employee - Employee No, Designation, Service Details ete. along with copy of ID Card of employee {ifemployed) attested by the company officials with seal and Signature on Company Letter Head 4 Attendance just before the death (in case employee) attested by company officials with seal 4 Salary Slips for3 Months prior to Accident -ifemployed attested by company officials and with seal. + Family Members Certificates - Original No Objection from other family members other than the Nominee 4 Aadharcard and PAN Card/VoterD /Ration Card of Deceased person and Nominee with self-attestation “All documents must be attested by the Company with Seal in case the Insured is employed. Above policy Terms & Conditions as per the associate Insurer The New India Assurance Company Limited (NIACL), Any correction or updating will be done accordingly as per the Insurer Guideline *\ ACCIDENT RELIEF CARE PVT. LTD. ap Ph: +91 80 40993666 /777 / 888, 9606666564 Wha gunn dost! E-mail : claims@accidentreliefcare.com H.0.: #2, nd Floor, Matadahalli Main Road B.0.: #11, (Design No, 38779), tst Floor, MLA layout, RT. Nagar, Bangalore - 560 032 Paramahamsa Road, Yadavagi, Mysore - $70 020 ABW Poyn move Agen / CLAIM PROCEDURE wine REORG Teche wirennie! GEAILENCCEENE % MaREeTO / ronepeRAO / LesoOMe / eaousoAMO walmME 48 TolIRMOKA DLO A EgOA wat UF sinbed sandra aumad adds xoriicemmay. @ UmENEher mere Bachas mered axed 20 Oantaenl aes sgeon Hks Rereicw. wsigesdl Oichstsy Sexes eowlirxtiemel macenrd Hoskpteh 491 9606666564, 8296161666, 08040993666 / 777 / 888 erm &-ehte* claims@accldentreliefcare.com #1 S-chte ean usm ons ies, came wes,cfacat Race, moorae. © srchoteg (Cash Less) motaccatnit, sitcichtayes exmsmn 24 reliridaek SUL R semtied (Ledacnrien Hag, or,Schat) aymay mace ZekaratA OMDaMAY. © 5 00st 65 sai hawhasich ang & xoxigg walrch Saeddrod xeid.gg 75 chaleriv See ctecens wonedxeembae. Dac mOoAT Rose 48 MoHeRA aah marne cosierQmOM (PRO) Heke eagrdd ceLsade, deb tages. Bavdarhod wssy sysid, vated Onno 30 ORrvaENS Dudes, 10,000/- UamroenvaeR awréqord ed seichEegpabes 31 Ox dosed meprtens, Sab wonriceeAOy. Ev@atnet uta, tise, engi mae tmchood noridleinme adnw Dera, 1,00,000/- (om oF) ce (Grrtggrs ino) ang katienTbEyeh Learned aes Log eA Bacdacnos stay defy shthansison srectsh, me Nensrleth, HOt Omoshod 7 tows Oaned shebenss mabe Lv@atho’ uday ciffd sboeciach stems, meena, OA Doctor 35 ond One shchmneta cmcbee Hog, aygeabes, sbaamteber, Ocho searh xowopact ase shod Pays aon way usdobsy dront! aan oon.o.am Omyny EmadeT mos aeoocee weg setok SETS, + RiQobo, Duar, capes, mbps, aoe, nonopad agree, oobt wonedtemTTOY. 24 rottnod ssh aiBodY LeCathoswn wsgobe, wdO|S voss ached, sexoXeMATD. nedatncaen usd sitts og megesh, wort meee Rgeecnr 30 AaMaNT ARCH shunsER, sam SoA, weds dibobss, cine mcreee, eontdmaoY. evdacnosmn weg adds agp nears, exigREMT Aer 45 OAMETA ARCH sebtaxthee, SaaRN Holey wos debobsy, odes medreee, onrdbagoy, © osapdle manmobrot Ulsns, YOST RgLod Yohomoh VARY, UP UaREN gods Oe, wet (Ee) aw LOE #03, setts shay shejanss, deat, ysN mob, cegciod, uayN awAdesys mob, meg|meried mae, 33 red EROAgHE cosu~He Oches HARE ENON dete Bou, xichtages geet mavenaren bosconmatoay, o Fe eee ee + Pow, sidcsdaod cose mdenars, AgoMno wes concpHOMTe shuren Scho cesdenarieR, shore aecdd Aaidor! 90 Oats LR Esse auITY sonnet dich ayenmeAoy, ‘meets, Say, Seba weaRslefah, Bacdancinn seg sonxenrayes Carnes MaaaRE, RoNeimERAO) shebanciSch ahah atau eigoh Aohob waanstgata, adobe engendt manenanem, dathod HOTSEy, Dobos chehmns mieketages enO crsdensries, (Original) Aoz3ery, had ahOch dypday Aebohey datieimn eeeOrd maX (Implants) sh, Lecdtohes, aad mor mee ‘ahah Cebricdodnst dosed deen Speech are Nain Paktevh ayoY teesBao creMox (Out Patient) momcsoD sawn, aimdaydesns HUBER CMSNED % SHgaH (Claim Form) sacs, ach wee Banc denonEeND Uo uate MNES, @ rmrdoon arson wamastto rochSe tL (Voter ID) UEDTT mEE (Aadhar Card) IDE mar (Pan Card wee AAA 3 (DL) pried cdepemns Lone ween sche, @ ingle death aEFT GesYUT RAED (Bank Pass Book front page copy) x= eos Sad aw sy swe wo, (Cancelled cheque leafcopy) 4 Sues amag tage mar HxeD (ARC Membership Card copy) 4 ued Rts apioee eatpesd! xomeror Aade! oidey Hg, (Medical certificate from the treating Doctor history and Line of treatment) 4 Rutt HAAS Ou ueHCHD (Vaccination Card) Bachck any nec ued ANT aie dacuité Aoskoe dawosacnd HLEGROT Ohm Ut Ome, choy Lote eROM auRN whi Moyem, keomEaRCY SAE urtichecoH womb Daren seod Snorbtayetee, 3-800 (X-Ray) 5 qoodesgrivs aasy wayne scdnvb (Reports) Hoxie, 8g nea Sieber Bete eu! (Prescription) soap Bniss worded Searten, wont Selaemucne sears (Lab Reports) soa 24% mA" Erb ne.uot 2 HEAT (C.T, MRIReports) emgxttes wrorish, abbansiSibatod dacO wctx{Dod walgns wwokmdd wif Mompter Aside, OOS dasidg wdob add alge, ARR xonsER, Loch see momréinvg emmns xeuns ane Hous tonnes UntECORE tonined atstrand (Letter Head) ctacaat Heinon sbtbanaterbsied Sato sbenaigem, NOxtte agp exo aepnvds eactsse, eee * wet denon (IN-PATIENT) sxtomacon anany admdaydesnd semdemd macsne Og exgeseas 20.90% 4 (MLC) sivsbaiseainee (FIR) SS meee slats mmzEE (Police intimation) Seba, ZOzekce nese de menrdened, manrdivd exgns wound devin Lbchor! dosineh Stelrandend (Letter Hoad) SENT votre i Hoaleror Said wanh shebamlSxbslod Saree atgzteh, ARC A xEziiich, a3 aca aypposs shames ats, S0ae A sinot ee sock aypIDon |o.ner.A eine SenAYEN say mUtesikh, Obs uasny NeasER, ubrikeds moveses Hg, (Discharge Summary) 2th tears (Fina Bill Sy; wese Osc (Break-Up) Rsoriel ete shay vosre sire meats Sinass eacont, aipipor! sede Rateiucu she Rate wortod near, dm, acer s, aad mA, oa! chet aototmuchel scone, saad shoe consgreid Setuads choot soa dxed ues Koue difes ¢—Soto ele (X-Ray Films) shad soon dongend daccttee evita mene Segre (Implantinvoices) Baphigob sears (mnsdens ate, ete Aate, mbobe Saterday wwtReccdod Uesod ead x3) pho nit mas ened an atecd of eagnsmeTe mnUE aeeRDA ag (DL) saRC HmrcOon Hateoacs some McbeRLts (Voter ID), UeRET meas (Aadhar Card), aS wear (PAN Card) SEG careajmctth Lond HBO wane, ABE, + es *All documents must be attested by the Company with Seal in case the Insured is employed. Above policy Terms & Conditions as per the associate Insurer The New India Assurance Company Limited (NIACL), Any correction or updating will be done accordingly as per the Insurer Guideline *