How to File a Claim

1. Fully filled-up/signed OP claim form. Name of patient and other details must be written by the doctor.
2. Medical certificate with diagnosis in-lieu of the claim form is acceptable but claim form still needs to be signed by the employee and the employer.
3. BIR approved official receipts for consultation fees, medicines and laboratories.
4. Prescription with quantity, dosage and frequency if there are meds for reimbursement.
5. For lab expenses, lab request signed by the concerned doctor is required. Photocopy is okay.
6. All documents must be original copies except lab request.
7. Erasures on claim documents, e.g., official receipts, prescriptions, lab requests, claim form must be countersigned by the authorized person – individual who issued the OR, prescription, lab request, claim form, etc.

*Etiqa Life and General Assurance Philippines, Inc. reserves the right to ask for additional requirements on a case to case basis.*

1. Fully filled-up/signed IP claim form.
2. Hospital Statement of Account (SOA) with details of charges – photocopy is okay.
3. BIR approved official receipts for hospital bills and doctors fees.
4. Medicines bought outside the hospital should have the corresponding prescriptions.
5. Records of operation if surgery was performed.
6. All documents except for the SOA and records of operation must be in its original form.
7. Erasures should be countersigned by the authorized signatory.

*Etiqa Life and General Assurance Philippines, Inc. reserves the right to ask for additional requirements on a case to case basis.*

Scan the following proofs of death and email them to LifeClaims@etiqa.com.ph.

1. Claimant’s statement

   This statement must be accomplished by the beneficiary/ies to whom the insurance proceeds are payable. If there is more than one beneficiary, a separate statement must be accomplished by each. If the insurance proceeds are payable to the estate or executor or administrator of the insured, the statement must be accomplished by an executor or administrator, a certification of whose appointment and qualifications must be submitted. If the insurance proceeds are payable to a minor, the statement must be accomplished by his/her legal or judicial guardian, an official certification of whose appointment and qualifications must be submitted. If the insurance proceeds are payable to a named beneficiary of legal age, the statement must be accomplished by such beneficiary. If the policy is assigned, the statement must be accomplished by the assignee. If a collateral assignment, a statement showing the consideration for same and present amount of indebtedness of the deceased under said assignment should also be submitted. The original deed of assignment must be submitted. If any beneficiary is dead, a certified copy of the death certificate of such beneficiary must be submitted. If the insurance proceeds or any part of it is payable to “children” or others of a class, a sworn statement must be submitted giving the name and date of birth of each child. If any have died, the statement must give the date and place of death, and must also state whether they died unmarried, intestate and without issue. If there was an official inquiry as to the cause of death, a duly certified copy of the verdict or findings must be submitted.

---

2. Attending physician’s statement This statement must be accomplished by every physician who attended the deceased during his last illness.

---

3. Identification of the Deceased
   • This statement must be accomplished by a person of legal age, intimately acquainted with, but not related to the deceased, who has seen the remains and has no interest in the policy proceeds.
   • All the foregoing statements must be properly dated and witnessed by a competent person of legal age. If death occurred outside the Philippines, a statement from a diplomat or consulate representative of the Philippines duly certified should also be submitted.
   • Besides proper accomplishment and submission of the above-prescribed Company’s claim forms, the following documents marked should be submitted also.
     • Policy Contract
     • Death certificate duly sealed and signed by the Office of the Local Civil Registrar
     • Birth certificate of the Insured and beneficiaries
     • Marriage contract
     • Letter of Guardianship – proof of judicial appointment of a guardian of the minor beneficiaries, if amount of proceeds is more than PhP 50,000
     • Affidavit of Guardianship to be executed by the natural parent
     • Police Investigation Report, if cause of death is accident, murder or homicide
     • Autopsy report / Post Mortem findings

*Etiqa Life and General Assurance Philippines, Inc. reserves the right to ask for additional requirements on a case to case basis.*

For Hospitalization Reimbursement, please submit the following:

1. Fully filled-up/signed In-Patient claim form
2. Hospital Statement of Account (SOA) with details of charges – photocopy is okay.
3. Medical/clinical abstract.
4. Records of operation if surgery was performed.
5. BIR approved official receipts for hospital bills and doctor’s fees.
6. Medicines bought outside the hospital should have the corresponding prescriptions.
7. All documents except for the SOA and records of operation must be in its original form.
8. Erasures should be countersigned by the authorized signatory.
9. Scanned copies may be emailed to claimsreimbursement@etiqa.com.ph.

For Accidental Dismemberment Claims, the following should be submitted:

1. Complete medical records.
2. Official police report.
3. Photo of the severed part of the body.
4. Scanned copies may be emailed to LifeClaims@etiqa.com.ph.

For Death Claims, the following are required:

1. Claimant’s statement

   This statement must be accomplished by the beneficiary/ies to whom the insurance proceeds are payable. If there is more than one beneficiary, a separate statement must be accomplished by each. If the insurance proceeds are payable to the estate or executor or administrator of the insured, the statement must be accomplished by an executor or administrator, a certification of whose appointment and qualifications must be submitted. If the insurance proceeds are payable to a minor, the statement must be accomplished by his/her legal or judicial guardian, an official certification of whose appointment and qualifications must be submitted. If the insurance proceeds are payable to a named beneficiary of legal age, the statement must be accomplished by such beneficiary. If the policy is assigned, the statement must be accomplished by the assignee. If a collateral assignment, a statement showing the consideration for same and present amount of indebtedness of the deceased under said assignment should also be submitted. The original deed of assignment must be submitted. If any beneficiary is dead, a certified copy of the death certificate of such beneficiary must be submitted. If the insurance proceeds or any part of it is payable to “children” or others of a class, a sworn statement must be submitted giving the name and date of birth of each child. If any have died, the statement must give the date and place of death, and must also state whether they died unmarried, intestate and without issue. If there was an official inquiry as to the cause of death, a duly certified copy of the verdict or findings must be submitted.

---

2. Attending physician’s statement

   This statement must be accomplished by every physician who attended the deceased during his last illness.

---

3. Identification of the Deceased
   • This statement must be accomplished by a person of legal age, intimately acquainted with, but not related to the deceased, who has seen the remains and has no interest in the policy proceeds.
   • All the foregoing statements must be properly dated and witnessed by a competent person of legal age. If death occurred outside the Philippines, a statement from a diplomat or consulate representative of the Philippines duly certified should also be submitted.
   • Besides proper accomplishment and submission of the above-prescribed Company’s claim forms, the following documents marked should be submitted also.
     • Policy Contract
     • Death certificate duly sealed and signed by the Office of the Local Civil Registrar
     • Birth certificate of the Insured and beneficiaries
     • Marriage contract
     • Letter of Guardianship – proof of judicial appointment of a guardian of the minor beneficiaries, if amount of proceeds is more than PhP 50,000
     • Affidavit of Guardianship to be executed by the natural parent
     • Police Investigation Report, if cause of death is accident, murder or homicide
     • Autopsy report / Post Mortem findings

Scanned copies of requirements may be emailed to LifeClaims@etiqa.com.ph..

*Etiqa Life and General Assurance Philippines, Inc. reserves the right to ask for additional requirements on a case to case basis.*

Please address Auto Insurance Claims to:

1. Notify Etiqa Philippines immediately as soon as possible upon receipt of notice of claim.
2. Submit the necessary claim documents.
3. If submitted pictures showing the damages are clear, Letter of Authority will be issued within 24 hours.
4. If submitted pictures showing the damages are unclear, Etiqa Philippines Claims Processor will inspect the vehicle within 48 hours.
5. Turn Around Time for Issuance of Letter of Authority (upon completion of claim documents).
   • PhP 100K and below (w/o inspection) - 1 day
   • PhP 100K and below (with inspection) - 2 days
   • PhP 100K and above (with inspection) - 2-5 days
6. If Own Damage and Third Party Property Damage claim is complicated, Etiqa Philippines will assign case to an Independent Adjuster.
7. For Bodily Injury claim, Etiqa Philippines will assign case to an Independent Adjuster.

*Etiqa Life and General Assurance Philippines, Inc. reserves the right to ask for additional requirements on a case to case basis.*

Please address Travel Insurance Claims to:

Compulsory Documents for All Claims

1. Completed Claims Form.
2. Letter of Request / Incident Letter.
3. Copy of Insurance policy.
4. Original Official Receipts of all payments made.
5. Copy of Passport (pages with details and dates stamped for entries and departures).

Supporting Documents for each benefit

1. Medical & Hospitalization expenses abroad:
   • Original medical report / abstract with Medical History of present illness
   • Clinical Test / Laboratory Results.
   • Detailed Original Hospital Statement of Account.
   • Copy of Operative and/or Histopathology Reports.
   • Police report (if applicable. Example: accidents).
2. Extension of period of stay of the insured as a result of illness or accident (accommodation expenses only):
   • Original medical report / abstract with Medical History of present illness.
   • Clinical Test / Laboratory Results.
   • Copy of Operative and/or Histopathology Reports.
   • Police report (if applicable. Example: accidents).
3. Emergency medical evacuation & repatriation:
   • Transport or repatriation in the event of covered illness/accident, arranged by Emergency Assistance Provider. Please call +632-8459-4752.
4. Repatriation of mortal remains:
   • Arranged by Emergency Assistance Provider. Please call +632-8459-4752.
5. Compassionate visit:
   • Original medical report / abstract with Medical History of present illness
   • Medical certificate from physician or hospital.
   • Clinical Test / Laboratory Results.
   • Copy of Operative and/or Histopathology Reports.
   • Police report (if applicable. Example: accidents).
   • Original Invoice & Official Receipt of the transportation and hotel expense of family member who took care of Insured Person.
   • Copy of flight itinerary and official receipts of Airfare.
6. Return of minor children:
   • Original medical report / abstract with Medical History of present illness
   • Medical certificate from physician or hospital.
   • Clinical Test / Laboratory Results.
   • Copy of Operative and/or Histopathology Reports.
   • Police report (if applicable. Example: accidents).
   • Original Invoice & Official Receipt of the transportation and hotel expense of family member who took care of the minor child.
   • Copy of flight itinerary and official receipts of Airfare.
7. Hospital daily income (up to 10 days):
   • Original medical report / abstract with Medical History of present illness.
   • Medical certificate from physician or hospital.
   • Clinical Test / Laboratory Results.
   • Copy of Operative and/or Histopathology Reports.
   • Police report (if applicable. Example: accidents).
8. Travel cancellation expenses:
   • Original medical report and/or Death Certificate of the Insured Person or the immediate family member.
   • Proof of relationship between Insured Person and the immediate family member.
   • Certification/Affidavit stating the reason for the trip cancellation.
   • Proof of occurrence of covered incident such as police report, fire fighter’s report, insurance insurer report, etc.
   • Original copy of invoice and receipts for proof of advance payment made for transportation and accommodation expenses issued by the agency or directly by the wholesaler (Airline & Hotel) and a copy of the travel voucher issued by the agency.
   • Copy of the general condition of sale of the wholesaler & retailer (Travel) agency.
   • Original cancellation document proving the non-refundable portion specified (e.g. travel agency’s certification, letter from the airline to the travel agency or client stating that the carrier can’t refund the airfare, and statement from the hotel regarding cancellation policies).
   • Other documents that will be required (depending on reason of the travel cancellation).
9. Trip curtailment:
   • Original medical report and/or Death Certificate of the Insured Person or the immediate family member.
   • Proof of relationship between Insured Person and the immediate family member.
   • Certification/Affidavit stating the reason for the trip curtailment.
   • Proof of occurrence of covered incident such as police report, fire fighter’s report, insurance insurer report, etc.
   • Original copy of invoice and receipts for proof of advance payment made for transportation and accommodation expenses issued by the agency or directly by the wholesaler (Airline & Hotel) and a copy of the travel voucher issued by the agency.
   • Copy of the general condition of sale of the wholesaler & retailer (Travel) agency.
   • Original cancellation document proving the non-refundable portion specified (e.g. travel agency’s certification, letter from the airline to the travel agency or client stating that the carrier can’t refund the airfare, and statement from the hotel regarding cancellation policies).
   • Original official receipts for the additional fees paid for the return ticket to home country such as no show fee, rebooking fees, penalties, etc.. with a copy of the new travel itinerary
   • Other documents that will be required (depending on reason of cutting the trip short).
10. Flight delay/ missed connecting flight/ flight diversion:
    • Original Certification from Airline
    • Original official receipts of expenses incurred due to incident.
    • Copy of the flight itinerary of the actual time and date of departure.
11. Baggage delay:
    • Original Property Irregularity Report (P.I.R.) from airline.
    • Original receipts of articles of basic necessity purchased due to delay of luggage.
    • Original acknowledgement receipt/form stating the exact date and time when the baggage was received by the Assured.
12. Compensation for in-flight loss or destruction of checked-in baggage:
    • Original Property Irregularity Report (P.I.R) from airline.
    • List of contents of the luggage with estimated price and date of purchase of each item.
    • Photograph of the damaged item and the original receipt and/or quotation for the repair.
    • Original certification of settlement of the compensation payment by the carrier.
13. Indemnity for theft of luggage or personal belongings not checked-in:
    • Original Police report from the place where incident occurred.
    • List of contents of the luggage.
    • Original purchase receipts & warranty cards (if applicable) for the items claimed.
    • Certification from hotel or any other party that the loss was not indemnified, or if settlement was made, certification specifying amount settled.
    • Picture of locks that were forcibly opened (if applicable).
    • Notarized affidavit for an official statement on what happened.
14. Loss of travel documents:
    • Original Police report from the place where incident occurred.
    • Original receipts of expenses for transportation and/or accommodation to go to the place where documents will be issued.
    • Original receipts for costs or fees to obtain new travel document.
15. Personal liability:
    • Original Police report
    • Should be reported to the Emergency Assistance Provider. Please call +632-8459-4752.
16. Personal accident:
    • Copy of Death Certificate.
    • Original Police Report.
    • Copy of Medical Report or Medical Certificate (if treated outside of accredited network).

*Etiqa Life and General Assurance Philippines, Inc. reserves the right to ask for additional requirements on a case to case basis.*

Please address Fire Insurance Claims to:

1. Claimant must prepare an incident report.
2. Claimant to send contact details (phone number and/or email address) to Etiqa Philippines’ General Insurance Claims Department.
3. Etiqa Philippines’ General Insurance Claims Department will assign an independent claims adjuster to handle the claim.
4. The independent adjuster will get in touch with the assured to schedule a meeting.
5. Upon the completion of the investigation, the claims adjuster will send final recommendations to General Insurance Claims Department for approval.