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All insurance contracts are based on the information provided by the insured in the proposal form. The proposal form forms the basis of insurance contracts.

In view of varied nature of policies, certain points distinct to individual policies, in addition to the above, are listed below: (Please note that the documents mentioned are indicative and based on the circumstances of the claim, insurer may request for additional documents)

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You can apply for a Health Insurance claim in 2 ways. You can either go for Cashless Claim or get Reimbursement for your claim. Given below are the procedures to be followed:

Cashless claims facility is available only with the network hospitals of the TPA we are tied with.  You are advised to understand  from our TPA before you get admitted, about current status of networking of any particular hospital.

Under this facility  the network hospital shall assist you in completing the formality related  to cashless request.  You can  also contact our Third Party Administrator through their helpline numbers , by quoting your Membership Number given on your health card.

Cashless claims are of two types:

  • Cashless Claims procedure for Emergency Admission
  • Cashless Claims procedure for Planned Admission

Cashless Claims procedure for Emergency Admission:

  • Step 1: In case of network hospital, on admission, intimate the Third party administrator (TPA) through their Toll free no. Please quote your health card Membership number 
  • Step 2: Fill in the cashless request form which is available with the Hospital Insurance Help Desk and get it certified by your treating doctor
  • Step 3: Fax the cashless request form along with supporting medical records to the TPA
  • Step 4: The TPA will scrutinize the document and convey the decision to the hospital. The TPA could sanction the cashless request or call for additional documents, if required.
  • Step 5: On approval of cashless claim by TPA, the hospital bills will be settled directly (subject to policy limits). Inadmissible amounts like telephone charges, food, attendant charges etc would have to be settled by you 
  • Step 6: If the cashless claim is not approved by TPA, please settle the bill with the hospital and apply for reimbursement. The claim will be processed as per policy terms and conditions 

The Turnaround time for approving Cashless decision by our TPA is 24 HOURS AFTER RECEIPT OF ALL DOCUMENTS.

Cashless Claims procedure for Planned Admission

  • Step 1:  Select a hospital from our list of network hospitals for treatment 
  • Step 2: Intimate our Third party administrator (TPA) through the Helpline Number before 3 days of admission, quoting your Health card Membership number 
  • Step 3: Fill in the cashless request form which is available with the Hospital Insurance Help Desk and get it certified by your treating doctor 
  • Step 4: Fax the cashless request form along with supporting medical records to the TPA
  • Step 5: The TPA will scrutinize the document and convey the decision to the hospital. The TPA could sanction the cashless request or call for additional documents, if required.
  • Step 6: On approval of cashless claim by TPA, the hospital bills will be settled directly (subject to policy limits). Inadmissible amounts like telephone charges, food, attendant charges etc would have to be settled by you .
  • Step 7: If the cashless claim is not approved by TPA, please settle the bill with the hospital and apply for reimbursement. The claim will be processed as per policy terms and conditions.

The Turnaround time for approving Cashless decision by our TPA is 24 HOURS AFTER RECEIPT OF ALL DOCUMENTS.

Procedure for Reimbursement of Claim

If you have not availed cashless facility in network hospital  or you have taken treatment in a hospital which is not a part of net work then you may submit your original documents for reimbursement.

  • Step 1:  Intimate IFFCO-Tokio through the toll number - 1800 103 5499 immediately on admission not later than 7 days from the date of discharge. Please quote your Policy Certificate Number while intimating the claim.
  • Step 2: Avail treatment and settle all the bills with the hospital and then file a claim for reimbursement.
  • Step 3: Download the relevant claim form from our website (or) request for one through our call centre.

Claim documents may also be submitted to local IFFCO TOKIO Office address which can be obtained by calling our Toll Number 1800 543 5499.

If you need a guidance on the claims process, you could also contact us through our Toll Numbers - 1800 543 5499.

Document checklist

Documents to be submitted in case of Reimbursement of Claim - Duly filled claim form along with Doctor's certificate 

  • Discharge summary
  • Bills
  • Prescriptions
  • Advance and final receipts
  • Diagnostic Test Reports, X Ray, Scan and ECG and other films

If required claim processing team shall seek further more documents other than the above listed ones.

Please Note:

  • Claims would be processed on receipt of all required documents and additional documents/information if any required will be called for after scrutiny of the claim
  • Cheque will be dispatched to you if the claim is admissible. If not, a repudiation letter would be sent to you
  • The turnaround time for Reimbursement claims is 20 days from the date of receipt of all documents

Payment of Claim

  • All claims under this Policy shall be payable in Indian currency. All medical treatments for the purpose of this insurance will have to be taken in India only.
  • IFFCO TOKIO shall not be liable to pay any interest/penalty for sums paid or payable under the policy other than as provided by IRDA regulations.
  • The claim if admissible shall be paid to the legal heir of the proposer in case  the proposer is not surviving at the time of payment of claim.

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All insurance contracts are based on the information provided by the insured in the proposal form. The proposal form forms the basis of insurance contracts. 

Some important points, which would help you in the claims procedure.

  • The loss or damage should be reported to the insurer immediately.
  • On receipt of claim intimation, the insurer will forward a claim form.
  • Submit the completed claim form along with an estimate of the loss to the insurer. It is preferable to submit an itemized estimate with separate values.
  • The insurer will arrange for inspection of the damaged items to assess the loss. In case of major losses, a specialist-licensed surveyor is deputed.
  • The insured has to provide the required documents to substantiate the extent of loss.
  • In case the cause of loss is not established, it is for the insured to prove that the loss or damage has occurred due to an insured peril.
  • On agreement of claim amount between the insured and the insurer, the claim is settled.
  • Excess as stated as per the Policy terms and condition will be deducted from the claim payable.

In view of varied nature of policies, certain points distinct to individual policies, in addition to the above, are listed below: (Please note that the documents mentioned are indicative and based on the circumstances of the claim, insurer may request for additional documents)

Motor vehicle (Private & two wheelers) claims

Claims under Motor  policies

  • Notice of an accident (not necessarily a claim) involving third parties should be reported to the insurers.
  • The insured may be interested to pay compensation without going into whether he is liable to pay or not. It is therefore an express condition of the policy that no claim should be admitted or a compromise arrived at, without the approval of the insurers.
  • In case of major claims, the insurers may be willing to defend criminal case against the driver also on the basis of which compensation claims may be decided in the civil courts.
  • Every accident involving third parties is required to be reported to police. M.V.Act provides that a third party victim can proceed against the insurers directly. If the alleged accident is not reported to the insurers, the insurers can consider this as violation of policy condition. In such circumstances, even if insurers are required to pay compensation by a court of law, they have an option of recovering such claim amounts from the insured for violation of specific policy condition.

       Procedure
Steps to be taken in case of an accident:

  • Notice of accident should be filed with IFFCO-Tokio General Insurance’s toll free number 1800 103 5499
  • If damage is a major one, the accident may be reported before the vehicle is removed from the spot so that the insurers can arrange for spot inspection of damage.
  • The vehicle may then be moved to a workshop, preferably to authorized workshop, for estimation of repair charges.
  • On receipt of completed claim form and estimate of repairs the insurers will arrange detailed inspection of damage and cost of repairs will be ascertained.
  • The insurers will ensure that a person duly licensed drove the vehicle at the time of accident and that the vehicle is the one insured in their books. To that end, they will verify the Registration Certificate and the Driving license of the driver who drove at the time of the accident.
  • Upon completion of the above procedure, the repairers will be authorized to carry out repairs. The insurer may undertake to settle the repair bills directly with the garage or reimburse the insured.

What to do in case of an Own Damage Claim?

  • In the event of an accident-Please arrange for medical attention if anyone suffers injuries. Take down particulars of other vehicles/people involved, if any. Please do not accept any negligence for the accident nor commit to anybody regarding compensation, if any.
  • In the event of injury, death, third party property damage, burglary, theft, house -breaking and damage due to malicious act, riot, strike and terrorist activity, immediate information to the police station concerned is essential.
  • If the accident is severe in nature, and the vehicle cannot be moved, ensure proper protection of the vehicle at the spot. Please do not attempt either to start the engine or drive the vehicle after the accident and before required repairs.
  • Arrange to shift the vehicle to the nearest garage of your choice and ask them to prepare a detailed estimate (labor charges with list of parts along with its prices)
  • Please do not dismantle or alter the accident condition of the vehicle or repair till the vehicle is surveyed/assessed by a surveyor. Also to ensure that no parts or accessories are missing at any point of time.
  • Inform us about any accident or loss immediately.
  • Please submit the duly/completely filled-in claim form to us.
  • Please contact us for guidance on the cashless facility to avail direct payment facility by us to such a repairer.
  • Documentation to be submitted for verification & return (along with a set of photo copies)
  • Original vehicle registration book (including the fitness certification, if it is a separate document)
  • Original driving license.
  • Documentation for submission
  • Copy of the police complaint (FIR)
  • Estimate of repairs.
  • We may seek additional document(s) or ask for clarification(s) for processing your claim and that depends upon the claim. Please arrange to submit the same.
  • All damages / losses will be surveyed and assessed by a surveyor / assessor and admissibility of the claim and mode of settlement is decided only after the process.

Please note: Ensure that you give us the correct & complete contact details (address /telephone no's / mail IDs in the claim form. If you receive any notice or summon with regard to the accident (other than criminal proceedings, if any), contact us with the petition copy. 

What to do in case of Theft claim?

  • If your car has been stolen, the first thing to do will be to file a police report.
  • Notify your insurance company as soon as you file the police report, this will help in case the thief has caused some damage to others with your car. Also please note, your insurance company will not process your claim if you have not filed a report with the police.
  • When you notify your insurance company, provide them all the details of loan/lease of your car along with the FIR.
  • Provide them with a description of your car, mileage, service record if any. Also submit the list of personal items stolen along with the car.
  • It is also important to inform your RTO of the theft.
  • Inform your financier immediately of the theft and ask them to discuss the case directly with your insurer this might expedite the claim process.
  • In case the police recover the vehicle, inform your insurer about the same.
  • If the vehicle is recovered, the Insurance company is liable to pay compensation on damages caused to the vehicle as per the terms and conditions of your policy and for stolen items if any, which are covered under your policy.
  • If the vehicle is not recovered, the police have to provide a Non-Traceable Certificate (NTC) and the court will have to give a final report under sec 173 Crpc.
  • If you have taken a car loan to purchase your car, the insurer will settle the amount directly to the financier. The settlement amount is on the Insured Declared Value (IDV). This might however differ based on usage and market value.

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24 Hour Worldwide Assistance

To assist you around the clock in case of any emergency when you are abroad, IFFCO-Tokio General Insurance has tied up with PHM Global and their address is

Paramount Healthcare Management Pvt.Ltd.
Travel Health Dept.
Elite Auto House, 1st Floor,
54-A, M.Vasanji Road,
Chakala, Andheri (E), 
Mumbai- 400093 
Tel: 00 91 22 40004216 / 40004219
Toll Free: 1 866 978 5205 (within USA) 
Fax: 00 91 22 67021259 / 260
E-Mail: travelhealth@phmglobal.com
 

 Dedicated Helpline number for IFFCO-Tokio General Insurance - 0091 22 67515551

In addition, you can avail of the following toll free numbers depending on the country you visit

 

Originating Country

International Access Code (+)

UIFN number

Australia 11 800-80008400
Austria 0 800-80008400
Belgium 0 800-80008400
China 0 800-80008400
Denmark 0 800-80008400
Finland 990 800-80008400
France 0 800-80008400
Germany 0 800-80008400
Hong Kong 1 800-80008400
Hungary 0 800-80008400
Ireland 0 800-80008400
Israel 14 800-80008400
Italy 0 800-80008400
Japan 001-010 800-80008400
Japan 0033-010 800-80008400
Japan 0061-010 800-80008400
Japan 0041-010 800-80008400
S.Korea 1 800-80008400
S.Korea 2 800-80008400
Malaysia 0 800-80008400
Netherlands 0 800-80008400
New Zealand 0 800-80008400
Norway 0 800-80008400
Philipines 0 800-80008400
Portugal 0 800-80008400
Singapore 1 800-80008400
Spain 0 800-80008400
Sweden 0 800-80008400
Switzerland 0 800-80008400
Thailand 1 800-80008400
UK 0 800-80008400

Way to dial a UIFN number from the originating country

The international access code + UIFN number
For example if the ITU UIFN number is 800 80008400, the way this number is dialled is 
international access code + 800 8000 8400.
For e.g.: The international access code for Australia is 0011, so the above number will be 
dialled as 0011 800 8000 8400 from Australia

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Personal Accident Claims

  • Immediate notification to the insurer.
  • In case of accidental death, the capital sum is paid to the legal nominee/assignee of the insured. If the insured fails to provide the name of the nominee, succession certificate from a court of law is necessary.

In case of other claims, the insurers may get the insured examined by a specialist or refer the matter to medical board as is necessary, the cost of which will be borne by the insurers.

Claims under Fire / IAR policies

  • Firstly the insured should take all possible steps to minimize the loss.
  • The fire brigade may be intimated immediately.
  • Lodge a police complaint in case of a fire arising out of - rioting mob, striking workers, malicious damage by third parties or terrorist damage.
  • Inform insurer as early as possible , in no case later than 24 hours
  • To co-operate with the surveyor appointed by the insurer by relevant information.
  • Obtain a meteorological report in case of loss due to cyclone, flood & inundation
  •  If the policy is on 'reinstatement basis', the claim is settled only after completion of repairs/replacement of the damaged items and submission of bills for claim payment.

Burglary Claims / Money Insurance / Fidelity

  • Immediately report to the police and obtain a non-traceable certificate that the items are not found.
  • Notify insurer as early as possible.
  • The insurers will insist upon a letter of undertaking on a stamp paper of appropriate value - letter of Subrogation, for refunding the claim amount when the stolen property is recovered.
  • Obtain a final report from Police.
  • Insured has to provide the surveyor complete book of accounts and bills substantiating the loss on the day of incidence.

Machinery Breakdown

  • Immediate notification to the insurer
  • Notice of claim and estimated cost of repairs should be filed with the insurers to arrange for inspection.
  • In case of partial losses, no depreciation is charged but when the items are not insured for its present day replacement value, the items are treated as underinsured and the claim amount is proportionately reduced. Depreciation is only applied for Total Loss claims.
  • If an appliance is partially damaged, it should be repaired (on approval from insurance company) before it is put to use, as otherwise further loss is not covered.

Electronic Equipments

  • Immediate notification to the insurer.
  • Notice of claim and estimated cost of repairs should be filed with the insurers to arrange for inspection.
  • In case of partial losses, No deduction shall be made for depreciation in respect of parts replaced, except those with limited life, but the value of any salvage will be taken into account.
  • If an appliance is partially damaged, it should be repaired (on approval from insurance company) before it is put to use, as otherwise further loss is not covered

Household goods in transit

  • In case any damage is suspected in transit, open delivery should be insisted upon the carrier and their certificate should be obtained.
  • In case of loss/damage in transit, a monetary claim should be lodged with the carrier within the time limit to protect recovery rights, without which, the claim may not be admitted.

Marine Transit Loss

  • Original Invoice & packing List - if forming part of Invoice
  • In case any damage is suspected in transit, open delivery should be insisted upon the carrier and their certificate should be obtained.
  • Original Lorry receipt (LR)/ Bill of Lading (BL )- Qualified with remarks for the Quantity damaged or lost in the transit.
  • In case of Declaration Policy - The consignment should be declared and the within the limit of balance Sum insured.
  • In case of loss/damage in transit, a monetary claim should be lodged with the carrier within the time limit to protect recovery rights.
  • Damage / Shortage Certificate from the carrier.
  • A surveyor ( mutually agreed by the Insurer) must be appointed to determine the nature, cause and extent of loss/damage.

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