File a Claim

OMNI is with you every step of the way. Our services don't end after helping you find the best plan. We also take on the most challenging part of having insurance by handling your claims for you. In the hospital, on the road, or even in another country, we're here for you 24/7.

Marine Insurance Claim

CONTACT: +63 917 595 6840 / [email protected]

Cargo Requirements:

  • Formal claim letter indicating Claim  Statement
  • Duplicate copy of the original Bill of Lading or Airway Bill
  • Duplicate copy of the original Commercial Invoice
  • Duplicate copy of the original Packing List
  • Duplicate copy of the original Bad Order Certificate
  • Duplicate copy of the Broker’s Delivery Receipt
  • Duplicate copy of the original Short Delivery/Short Landed Certificate
  • Certified cost of repair
  • Assured formal claim letter (all stamped “RECEIVED”) filed against:
    • Shipping Company
    • Arrastre Operator
    • Brokerage

Documentary Requirements for Marine Hull Claim:

  • Copy of Vessel’s Certificate of Registry
  • Copy of Vessel’s Certificate of Ownership
  • Copy of Vessel’s Coastwise License
  • Copy of Vessel’s Departure Clearance
  • Copy of Vessel’s Certificate of Inspection/Survey Report
  • Master’s Note of Protest
  • Repair Estimate of the damaged vessel
  • Deck Logbooks/Extracts covering the repair period
  • Statement of Cost and Expenses of towing
  • Original Survey Reports and Bill
  • Statement of fees and expenses incurred in attending the casualty and diving survey

MSPR Claim

CONTACT: +63 917 595 6840 / [email protected]

Requirements: 

  • Formal claim letter indicating the following
    • Details of the incident
    • If available, name and contact details of Witnesses
  • Police Investigation Report
  • Sworn Statement of the victim and witness
  • Supporting documents such as:
    • Audit Report
    • Check or Cash Vouchers
    • Collection Report/Provisional Receipts/Official Receipt
    • Payroll Sheet (for payroll robbery)
    • Replenishment Report (for petty cash)

Equipment/Property Floater/Special Risk Claim

CONTACT: +63 917 595 6840 / [email protected]

Equipment/Property Floater/Special Risk

Requirements:

  • Detailed Incident Report
  • Police Investigation  Report, if available
  • Pictures of the damaged property or affected insured item
  • Repair Estimate or Quotation if the unit is for replacement
  • Photocopy of the contract or agreement if the property is rented

EEI Claim

CONTACT: +63 917 595 6840 / [email protected]

Requirements:

  • Affidavit stating the nature of the loss or Police Investigation Report
  • Incident Report
  • Pictures of the damaged item
  • Repair Estimate or Quotation (nearest specification if the loss/ damaged items are obsolete)
  • Technical Report
  • Official Receipts, Sales Invoice or Purchase Orders (as proof of acquisition)

Fidelity Guaranty Claim

CONTACT: +63 917 595 6840 / [email protected]

Fidelity Guaranty Claim Requirements:

  • Excerpts from 201 File of the erring employee:
    • Application for Employment
    • Interview Sheet
    • Resume and/or Personal Data
    • Letters of Appointment
    • Notice of Personnel Action
    • Job Description
  • Audit Report and its corresponding schedules
  • Certificate and computation of the amount due and withheld from the erring personnel indicating the following:
    • Unearned salary
    • 13th month pay
    • Withholding Tax Refund
  • Internal Control Procedures of the Company
  • Information whether a case was filed against the erring personnel such:
    • Prosecutor’s Office Investigation Data Form
    • Prosecutor’s Office Assessment Form
    • Complaint Form
    • Sworn Statements
    • Affidavit and Counter-Affidavit
    • Court Orders and/or Subpoenas
    • Resolution
  • Incident Report
  • Demand Letter addressed to the erring personnel
  • Information as to the disciplinary actions taken by the Company to recover the loss from the erring personnel
  • Memorandum and formal letter of explanation/reply
  • Breakdown of the amount of claim and its supporting documents

Contractor’s All Risk/Erection All Risk Claim

CONTACT: +63 917 595 6840 / [email protected]

Contractor’s All Risk/Erection All Risk Claim Requirements:

  • Police Report and/or Incident Report (detailed)
  • Plan, design and specifications
  • Building Permit 
  • Detailed Repair Estimate or Quotation for replacement
  • List of Bid Items
  • Original and/or revised PERT/CPM
  • Expert’s report on soil and ground conditions
  • Pictures of the affected properties
  • Medical Certificate, Official Receipts and Medical Test for Bodily Injury claim

Business Interruption/Loss of Profit Claim

CONTACT: +63 917 595 6840 / [email protected]

Non-Manufacturing

  • Incident Report or Affidavit
  • Income Statement
  • Monthly Sales Report (at least two years)

Manufacturing

  • Audited Financial Statement
  • Operation Procedures
  • Inventory Report
  • Monthly Sales Report

Livestock Claim

CONTACT: +63 917 595 6840 / [email protected]

 Requirements:

  • Detailed Incident Report
  • Affidavit and Proof of Ownership
  • Pictures of the affected items
  • Veterinary Report
  • Livestock Certificate
  • Police Investigation Report, if available

Liability Claim

CONTACT: +63 917 595 6840 / [email protected]

Requirements:

  • Detailed Incident Report
  • Police Investigation  Report
  • Property Damage
    • Picture of the damaged property
    • Repair Estimate
  • Bodily Injury
    • Medical Certificate
    • Official Receipts and other pertinent medical documents
  • For Professional Indemnity claim, photocopy of the Contract

Fire and Allied Perils Claim

CONTACT: +63 917 595 6840 / [email protected]

General Requirements:

  1. Copy of insurance the insurance policy including warranties, clauses and endorsement(s).
  2. Picture of the affected property
  3. Incident Report stating the details of the incident
  4. Affidavit of Loss with the estimated amount of claim
  5. Fire Investigation Report from Bureau of Fire Protection
  6. Inventory List of affected and not affected contents showing the acquisition cost and purchase date
  7. Quotations to repair and/or replace the damaged contents
  8. The claimant is also required to accomplished the following Forms:
    1. Sworn Statement of Claim
    2. Non Waiver Agreement

For Building Claim:

  • Item numbers 1 to 8 of the General Requirements
  • In case of a partial loss, detailed repair cost of the building showing the breakdown of materials, labour and overhead per scope of work required. This must be prepared by a civil engineer or architect and is for the account of the insured
  • Appraisal Report, if available
  • Certified copy of Building Permit or documents showing the date of construction or establishment of the building
  • Copy of the Building Plan showing dimensions and specifications
  • A certified true copy of Transfer Certificate of Title and/or Deed of Sale, Declaration of Real Property

For Machinery and Equipment/Household Furniture, Fixtures and Fittings/Contents:

  • Items numbers 1 to 8 of the General Requirements
  • Official Receipts, Sales Invoice or Proof of Acquisition, if available
  • Building Contents Lay-out

For Goods and Merchandise Claim: 

  • Item numbers 1 to 8 of the General Requirements
  • A detailed inventory of the damaged goods showing the cost, the extent of damage and salvage value
  • Inventory Report showing:
    • Location of each item (for goods with different warehouse or location)
    • Raw Materials Inventory
    • Goods in Process
    • Finished Goods
    • Monthly Stock Declaration
  • A certified true copy of Income Tax Return
  • Latest Financial Statement 

Migrant Worker Claim Requirements

CONTACT: +63 918 922 0304 / [email protected]

Death Claim – Natural Death

  • Death Certificate (certified true copy) and duly authenticated by the Philippine Foreign post if death occurred outside the Philippines. 
  • Contract of Employment / Passport (Copy)

Document required from the beneficiary(ies):

  • Birth certificate of the OFW (if beneficiary is/are the parent(s))
  • Birth certificate of the beneficiary (if the beneficiary is a child)
  • Marriage contract (if beneficiary is the spouse)
  • Affidavit of legal guardianship (if the beneficiary is a minor)
  • Any government Identification e.g. SSS, TIN, Driver’s license, Passport, Postal Identity card, etc. of the benefiary(ies) – if beneficiary(ies) is/are the parent(s), spouse, or any adult beneficiary(ies) and legal guardian(s) of the beneficiaries who is/are minors. 
  • Other documents as may be necessary to establish the identity of the beneficiary(ies)

Death Claim – Accidental Death

  • Death Certificate (certified true copy) and duly authenticated by the Philippine Foreign post if death occurred outside the Philippines. 
  • Police Report, if available, duly authenticated by the Philippine Foreign post if death occurred outside the Philippines.
  • Contract of Employment / Passport (Copy)

Document required from the beneficiary(ies)

  • Birth certificate of the OFW (if beneficiary is/are the parent(s))
  • Birth certificate of the beneficiary (if the beneficiary is a child)
  • Marriage contract (if beneficiary is the spouse)
  • Affidavit of legal guardianship (if the beneficiary is a minor)
  • Any government Identification e.g. SSS, TIN, Driver’s license, Passport, Postal Identity card, etc. of the benefiary(ies) – if beneficiary(ies) is/are the parent(s), spouse, or any adult beneficiary(ies) and legal guardian(s) of the beneficiaries who is/are minors.
  • Other documents as may be necessary to establish the identity of the beneficiary (ies)

Repatriation

  • POLO certificate or written statement from the OFW
  • Passport copy (date of arrival)
  • eticket
  • Proof of payment (showing who paid for the repatriation ticket)
  • Employment Contract

Medical Repatriation

  • Medical Reports from abroad 
  • Passport copy (date of arrival)
  • E-ticket
  • Proof of payment (showing who paid for the repatriation ticket)
  • Pre-deployment Medical exam results
  • Other documents as may be necessary to establish the recommendation to repatriate

Money Claims

  • Original or scanned copy of NLRC complaint, quitclaim & order/ notarized quitclaim & release
  • Employment contract
  • OEC
  • Written statement from the OFW
  • Passport copy (date of arrival)

Compassionate Visit

  • Medical Report from abroad
  • E-ticket or round trip ticket
  • Proof of payment (showing who paid for the repatriation ticket)

Medical Evacuation

  • Complete and valid Medical reports and certification from the doctor(s) or hospital(s) in the receiving country which: (a) states the current medical condition of the OFW; and (b) letter, certification, or any written report by the doctor(s) or hospital(s) in the receiving country stating that there is no adequate medical facility available proximate to the OFW thus, necessitating the OFWs medical evacuation; and  (c) appropriate medical supervision is necessary during the medical evacuation.   
  • Who paid for the medical evacuation;
  • The costs of the medical evacuation with complete breakdown. 

                   

Subsistence Allowance

  • Certification issued by the concerned labour attaché. Or the embassy or consular official stating the title of the legal case the OFW are involved, the names of the parties, the nature of the cause of action of the OFW and the court or quasi-judicial body before which the case is pending.
  • Copy of the employment contract   

Permanent Total Disability 

  • Certified copy of complete medical records
  • Copy of employment contract
  • Copy of passport (date of arrival)

Travel Claim

CONTACT:
+63 917 595 6840 / [email protected] (NON-LIFE)
+63 918 922 0304 / [email protected] (MEDICAL)

BASIC CLAIMS REQUIREMENTS

  • Duly accomplished Notification of Claim (NOC) Form
  • Copy of Travel Official Confirmation of Coverage (OCC)
  • Copy of passport pages showing the dates of departure and arrival corresponding with the Itinerary on the OCC 
  • Original Itinerary (e.g., Itinerary or e-ticket purchased prior to the commencement of the trip)

MEDICAL AND EMERGENCY TREATMENT BENEFIT

For Out-Patient Treatment

  1. Basic Claims Requirements
  2. Completely filled out Attending Physician’s Statement for Out-Patient Treatment (located on the last page of the NOC)
  3. Original Official Receipt of all payments made with payment details 

If Applicable:

  • Photocopy of Drug prescription stating the diagnosis from the Attending Physician
  • Photocopy of Doctor’s request for laboratory procedure 
  • Photocopy of laboratory results
  • Photocopy of Certificate from facilities (e.g., Certificate Card or ID of Scuba driver or accompanying scuba driver/instructor, ATV tour guide, etc.)

If Out-Patient surgical operation was done:

  • Photocopy of the Operative Report (includes information on the nature, extent and stage of illness which may not be seen in other documents submitted), if applicable

If Injured as a result of an Accident:

  • Incident or Accident Report
  • Original Police Report for vehicular Accident 
  • Other documents deemed necessary by the Company

For In-Patient Treatment 

  1. Basic Claims Requirements
  2. Completely filled-out Attending Physician’s Statement for In-Patient Treatment (located on the last page of the NOC)
  3. Original and full Medical Report (pertaining to the Confinement) from the hospital or Attending Physician/s (e.g., clinical abstract or admitting history, discharge summary, etc.)
  4. Original Official Receipts of all payments made with payment details 
  5. Statement of Account (summarized and itemized) from the Hospital 
  6. Photocopy of the laboratory results
  7. Photocopy of Doctor’s prescription stating the diagnosis for home medication

If Applicable:

  • Photocopy of Certification form facilities (e.g., Certification Card or ID of scuba diver or accompanying diver/instruction, ATV tour guide, etc.)

If In-Patient surgical operation was done:

  • Photocopy of Operative Report (includes detailed description of surgical procedure)
  • Photocopy of Histopathology Report (includes information on the nature, extent and stage of illness which may not be seen in other documents submitted), If applicable 

If Injured as a result of an Accident:

  • Incident or Accident Report 
  • Original Police Report for vehicular Accident
  • Other documents deemed necessary by the Company

HOSPITAL INCOME BENEFIT 

  1.  Basic Claims Requirements
  2.  Requirements of In-Patient Claims

FUNERAL AND BURIAL EXPENSES BENEFIT

  1.  Basic Claims Requirements 
  2.  Photocopy of Death Certificate and relevant Coroner’s Report
  3. Original Official Receipt for the funeral and burial expenses incurred 
  4. Original Police Report (if the Accident was reported to the police authorities  (e.g., vehicular Accident)

PERSONAL ACCIDENT BENEFIT

  1.  Basic Claims Requirements
  2.  Doctor’s official and original written diagnosis
  3.  Full Medical Report establishing the loss of limb or loss of sight or total and permanent disability or death
  4. Original Police Report (if the Accident was reported to the police authorities e.g, vehicular Accident)
  5. Photocopy of the Death Certificate and the relevant Coroner’s Report, in case of death

PERSONAL LIABILITY BENEFIT

  1.  Basic Claims Requirements 
  2.  Original Official Receipt incurred for such liability 
  3. Any legal document/s establishing that payments have been made by the Insured to the injured/deceased party, in case the original Official Receipts or bills are not in the name of the Insured

If Applicable:

  • Original Police Report, for other circumstances 
  • Other documents deemed necessary by the Company to establish the legality of the claim

For Accident Bodily injuries to another person:

  • Full Doctor’s Report stating details of the Injury treated, Medicines prescribed and the services rendered
  • Original Official Hospital bills and/or Statement of Account

If Death to another person shall have resulted:

  • Photocopy of the Death Certificate and the relevant Coroner’s Report

For Accidental Loss or Damage to another person’s property: 

  • Certification from carrier/hotel/any other office/entity or any proof satisfactory to the Company for the accidental loss or damage to the property

LAND VEHICLE RENTAL EXCESS PROTECTION BENEFIT

  1.  Basic Claims Requirements
  2.  Photocopy of the vehicle rental contract or agreement 
  3. Original Official Receipt of the rental fee and damage fee in excess of the rental company’s insurance coverage
  4. Original Police Report (if the Accident was reported to the police authorities e.g., vehicular Accident)
  5. Original Affidavit received by the rental company stating the facts of the Accident 
  6. or damage to the rented vehicle.

BAGGAGE DELAY BENEFIT

  1.  Basic Claims Requirements 
  2. Original Baggage, Irregularity Report issued by the airline or carrier 
  3. Original Acknowledgement Receipt or form stating the exact date and time when the baggage was retrieved 

LOSS OF BAGGAGE ABD PERSONAL EFFECTS BENEFIT

  1. Basic Claims Requirement 
  2. Original Baggage Irregularity Report issued by the airline/carrier/hotel or any party in case the loss occurred while such baggage and/or personal effects was under their custody 
  3. Certification or any proof satisfactory to the Company issued by the airline/carrier/hotel or any party that the lost baggage and/or personal effects were not indemnified, or Certificate of Settlement specifying the amount settled
  4. Original Official Receipt for the purchase of the lost baggage. If not available, submit an Affidavit for Lost Official Receipt indicating the amount, brand, model, and type.
  5. Original Official Receipts for purchase of the lost personal effects. If not available, submit an Affidavit for Lost Official Receipt indicating the amount, brand, model and type
  6.  List of items lost (baggage and personal effects), indicating the amount, brand, model, and type
  7. Photocopy (unless original is requested by the Company) of the Doctor’s prescription for the lost Medicine

If Applicable:

  • Original Police Report for loss due to other circumstances 

Note: The Company will cover the cost of the lost baggage subject to depreciation but shall not exceed the maximum benefit limit. Personal effects include clothing, prescribed Medicines, bags, footwear, etc.

DAMAGE TO BAGGAGE AND PERSONAL EFFECTS BENEFIT

  1.  Basic Claims Requirements
  2.  Original Baggage Irregularly Report issued by the airlines/carrier/hotel or any party in case the loss occurred while such baggage and/or personal effects was under their custody
  3.  Certification or any proof satisfactory to the Company issued by the airline/carrier/hotel or any party that the lost baggage and/or personal effects were not indemnified, or Certification of Settlement specifying the amount settled
  4. Original Official Receipt for the purchase of the lost baggage. If not available, submit an Affidavit for Lost Official Receipt indicating the amount, date of purchase, brand, model, and type.
  5. Original Official Receipts for the purchase of the lost personal effects, If not available, submit an Affidavit for Loss Official Receipt indicating the amount, brand, model, and type.
  6. List of damaged items (baggage and personal effects)
  7. If already repaired, original Official Receipt for the cost of repair with corresponding details 
  8. If not repairable, a Certificate from a registered repair company that baggage is irreparable. 

If Applicable:

  • Original Police Report for loss due to other circumstances 

Note: The Company will cover the cost of the damaged baggage subject to depreciation but shall not exceed the maximum benefit limit. Personal effects include clothing, prescribed Medicines, bags footwear, etc.

LOSS OF LAPTOP BENEFIT

  1.  Basic Claims Requirements 
  2.  Original Baggage Irregularity Report issued by the airline/carrier/hotel or any party in case the loss occurred while such laptop was under their custody
  3. Certification or any proof satisfactory to the Company issued by the airline/carrier/hotel or any party that the lost laptop was not indemnified, or Certification of Settlement specifying the amount settled
  4. Original Official Receipt for the purchase of the lost laptop. If not available, submit an Affidavit for Lost Official Receipt indicating the amount, date of purchase, brand, model, and type.

Applicable:

  • Original Police Report for loss due to other circumstances

THEFT OF CASH BENEFIT

  1.  Basic Claims Requirements
  2.  Original Police Report is required in all instances

LOSS OF TRAVEL DOCUMENTS BENEFITS

  1. Basic Claims Requirements
  2. Original Police Report is required in all instances
  3. Original Official Receipts for the replacement fee of lost passport, unused visa and re-issuance of travel tickets of the same class
  4. Photocopy of the replacement of passport, visa and re-issued travel tickets
  5. Original Official Receipts for the travel and unplanned accommodation expenses

If Applicable:

  • Original Itinerary, if claiming for lost travel tickets
  • Original Baggage Irregularity Report issued by the airlines/carrier/hotel or any party in case the documents were lost within their premise

EMERGENCY TRIP CANCELLATION BENEFIT

  1.  Basic Claims Requirements 
  2.  Proof of advance payment made for travel fare and accommodation expenses, penalties and other irrecoverable pre-paid charges related to the trip
  3. Legal document proving trip cancellation with the non-refundable portion specified (e.g., Certification from Travel Agency or Tour Operator, a letter from the Airlines/Carrier, Certification from the Hotel)

If Applicable:

  • Photocopy of the Death Certificate, in case of death 
  • Original and full Doctor’s Report on the emergency medical treatment  of the Insured or his Immediate Family, within the degree of relationship specified in the Policy
  • Original Physician’s written declaration of the patient being unfit to travel 
  • In case of medical treatment or death of the Insured’s Immediate Family, please submit the following documents:
  • Necessary Birth Certificate/s and or Marriage Certificate/s to prove the relationship with the immediate family member or
  •  Notarized Insured’s declaration or relationship with the Immediate Family member 
  • Original Police Report, in case of lost travel documents 
  • Public documents (e.g., newspaper, magazines, etc.) online news and/or official advisory that report natural catastrophe, an unexpected outbreak of strike, riot, civil commotion or sudden acts of Terrorism
  • Original Irregularity Report issued by the airlines/carrier/airport stating the reason for the cancellation

EMERGENCY TRIP TERMINATION BENEFIT

  1. Basic Claims Requirements
  2. Proof of advance payment made for travel fare and accommodation expenses, penalties and other irrecoverable pre-paid charges related to the trip 
  3. Legal document proving trip termination with the non-refundable portion specified (e.g., Certification from Travel Agency or Tour Operator, Letter from the Airlines/Carrier, Certification from the Hotel)

If Applicable:

  • Photocopy of the Death Certificate, in the cue of death 
  • Original and full Doctor’s Report on the emergency medical treatment of the Insured or his Immediate Family, within the degree of relationship specified in the Policy
  • Original Physician’s written declaration of the patient being unfit to travel 
  • In case of medical treatment or death of the Insured’s Immediate Family, please submit the following documents:
  •  Necessary Birth Certificate/s and/or Marriage Certificate/s to prove the relationship with the Immediate Family member or
  •  Notarized Insured’s declaration of relationship with the Immediate Family member 
  • Original Police Report, in case of lost travel documents 
  • Public documents (e.g., newspaper, magazines, etc.), online news and/or official 
  • The advisory that reports natural catastrophe, an unexpected outbreak of strike, riot, civil commotion or sudden acts of Terrorism 
  • Full and original Medical Report and original Official Receipts for the unplanned accommodation expenses, in case of Insured’s Hospital discharge preventing the return to the Point of Origin as scheduled 
  • Original Irregularly Report issued by the airline/carrier/airport stating the reason for the cancellation

FLIGHT DELAY BENEFIT

  1. Basic Claims Requirements 
  2. Original Irregularly Report issued by the airline/carrier/airport or the preceding bus line, shipping line or rail authority stating the reason of the delay
  3. Any documentation showing actual flight taken, (e.g., boarding pass, updated Itinerary or Irregularity Report detailing the actual schedule)

MISSED CONNECTING FLIGHT BENEFIT

  1. Basic Claims Requirements
  2. Requirements of Flight Delay Claims
  3. Original Itinerary for the connecting flight schedule (e.g., Itinerary or e-ticket purchased prior to the commencement of the trip)
  4. Any documentation showing actual flight taken for the connecting flight schedule (e.g., boarding pass, updated itinerary or Irregularity Report detailing the actual schedule)

STRIKE AND HIJACKS BENEFIT

  1. Basic Claims Requirements 
  2. Copy of the Itinerary or travel ticket corresponding to the delay in reaching the destination
  3. Original Incident Report or Certificate from the airline/carrier/public conveyance that a strike or hijack occurred 

ALTERNATIVE MEANS OF TRANSPORTATION BENEFIT

  1. Basic Claims Requirements
  2. Original Irregularity Report issued by the airline/carrier/airport stating the reason for the cancellation or delay
  3. Any documentation showing actual flight taken (e.g., boarding pass, updated itinerary or Irregularity Report detailing the actual schedule)
  4. Original alternative public transport Itinerary public transport expenses

TRIP POSTPONEMENT BENEFIT

  1. Basic Claims Requirements
  2. Original Irregularity Report issued by the airline/carrier/airport stating the reason of the cancellation or delay
  3. Any documentation showing actual flight taken (e.g., boarding pass, updated Itinerary or Irregularity Report detailing the actual schedule)
  4. Proof of advance payment made for travel fare and accommodation expenses penalties and other irrecoverable pre-paid charges related to the postponed trip
  5. Legal documents proving trip postponement with non-refundable portion specified (e.g., Certification from Travel Agency or Tour Operator, Letter for the Airlines/Carrier, Certification from Hotel)

DISCLAIMER: 

Kindly note that the submission of the required claims documents does not guarantee approval of your claim. Your claim will be reviewed and evaluated based on the available documents submitted and subject to the limits, terms and conditions of your existing Policy.

The Insurance provider reserves the right to request additional documents as deemed necessary.

NOTES: 

  • If the document presented is written in a language other than Filipino or English, the appropriate translation fee will be deducted from the approved claim amount. All sections of NOC must be completed. Please write legibly.
  • If space is insufficient, please attach additional details on a separate sheet. Additional copies of the Notification of Claim (NOC) form are available upon request from Pacific Cross. you may also photocopy the form as needed.

Medical Claim Requirements

CONTACT: +63 918 922 0304 / [email protected]

BASIC REQUIREMENTS:

  • Duly-accomplished Notification of Claim (NOC) form
  • Original official receipt(s) of all payments made
  • Drug prescription from the attending physician 
  • Admitting Medical history (includes a detailed history of present illness; family, personal and past medical history)
  • Discharge summary report (includes patient’s course in wards, diagnostic tests requested and medications given)
  • Statement of Account (summarized and itemized)
  • Supporting charge slips of the statement of account in cases where the hospital has no itemised SOA
  • Copy of results of laboratory, X-ray, other diagnostic exams and therapeutic services

If a surgical procedure was done:

  • Copy of Operative Report (includes a detailed description of surgical procedure done) and Histopathology Report (includes information on the nature, extent and stage of illness which may not be seen in other documents submitted)

If a Private Duty Nurse was deemed necessary:

  • Referral letter/slip from the attending physician

For a Private Duty Nurse was deemed necessary:

  • Basic Requirements for In-Patient claims 

For injury as a result of an accident:

  • Basic Requirements for In-Patient claims
  • Copy of police report
  • Incident Report

In the event of Death of the Member:

  • Copy of Registered Death Certificate 

If applicable:

* Requirements for In-Patient claims

* Copy of police report

For Overseas claims:

  • Basic Requirements for In-Patient claims
  • Proof of Overseas stay (e.g., airline ticket of the actual flight taken, boarding pass, immigration stamps in the passport or proof of entry and exit tickets where immigration stamps are not applicable)

FOR OUT-PATIENT CLAIMS 

BASIC REQUIREMENTS:

  • Duly-accomplished Notification of Claim (NOC) form 
  • Original official receipt(s) of all payments made (with an itemized summary of charges)

If applicable:

* Copy of the drug prescription from the attending physician 

* Copy of request for laboratory, X-ray, other diagnostic exams and therapeutic services 

* Copy of results of laboratory, X-ray, other diagnostic exams and therapeutic services

In case an Out-Patient operation was done :

  • Copy of Operative Report (includes a detailed description of surgical procedure done) and Histopathology Report (includes information on the nature, extent and stage of illness which may not be seen in other documents submitted)

For injury as a result of an accident:

  • Basic requirements for Out-Patient claims 
  • Copy of police report 
  • Incident report 

For Overseas claims:

  • Basic requirements for Out-Patient claims 
  • Proof of Overseas stay (e.g., airline ticket, boarding pass or immigration stamps in the passport)

For Optical claims:

  • Basic requirements for Out-Patient claims 
  • A prescription from Ophthalmologist or Optometrist with the required quantity must be indicated if claiming for disposable contact lenses 

DISCLAIMER: Kindly note that the submission of the above-mentioned documents does not guarantee approval of your claim. Your claim will be reviewed and evaluated based on available documents submitted and subject to the limits and the terms and conditions of your existing Agreement. 

Pacific Cross reserves the right to request additional documents as deemed necessary.

NOTE: If the patient has other medical insurance or healthcare coverage, a certificate of Claim Settlement/Payment from another insurer or HMO company must be attached to this Notification of Claim (NOC) form along with all applicable requirements listed herein. 

Standard Death

STANDARD DEATH CLAIM REQUIREMENTS

  • Notice of Claim Form (to be released with the official letter)-to be signed by the authorized signatory of the Company
  • Time Cards or Attendance Record for the last month prior to death  (CERTIFIED COPY)
  • Claimant’s Statement (to be released with the official letter) 
  • Attending Physician’s Statement (to be released with an official letter)
  • Original/Certified true copy of the Death Certificate
  • Original/Certified true copy of the insured’s proof of age (i.e. passport, birth/baptismal certificate
  • Obituary/Newspaper clippings, if any
  • Payslips/SSS R-3 Collection List a month prior to the date of death (original or certified true copy)   

IN CASE OF BENEFICIARY IS SPOUSE OF THE INSURED

  • Original/Certified true copy of the Marriage Contract

IN CASE BENEFICIARIES ARE CHILDREN OF THE INSURED

  • Original/Certified true copy of the beneficiaries’ proof of age (if there is an indication that the beneficiaries are below 18 years of age – i.e. passport, birth/baptismal certificates)

IN CASE OF MINOR BENEFICIARY/IES

  • Affidavit re Guardianship with Notarial Seal (PARENT) – form to be released by Sun Life

(This will be required if the interest of the minor is Php 150,000 and BELOW and the parent is acting on the beneficiary’s behalf)

  • Affidavit re Guardianship with Notarial Seal (OTHER THAN PARENT)-to be released by Sun Life

–  If the interest of the minor beneficiary is Ps 50,000 and BELOW

  • A Bond Approved by a Competent Court (PARENT)

–  This will only be required if the interest of the minor is ABOVE Ps 100,000

  • Letters of Guardianship (OTHER THAN PARENT)

–  If the interest of the minor beneficiary is ABOVE Ps 50,000

IN CASE THE INSURED DIED ABROAD

  • Death Abroad Questionnaire  (to be released with an official letter)
  • Other documents related to the death including passport 

IN CASE OF AN ACCIDENT

Where an Accidental Death Benefit claim is involved, death is suspected suicide or homicide or caused by unusual or unclear circumstances, the following documents have to be submitted:

  • Original/Certified true copy of the Police Report
  • Original/Certified true copy of the Autopsy/Toxicology Report
  • Original/Certified true copy of the Paraffin Test/Ballistic Report
  • Newspaper accounts of details surrounding the death, if any

IN CASE OF NO ENROLMENT CARD

  • Certification from the duly authorized signatory confirming the civil status of the deceased employee and the name(s) of the beneficiary(ies) based on the claims provision of the policy contract.

HIERARCHY PROVISION RE-DESIGNATION OF BENEFICIARY/IES

If no beneficiary is alive on the date of the Employee’s death, or if the Employee fails to designate a beneficiary, or if the designated beneficiary is disqualified as ordered by law, the insurance proceeds shall be payable to the first surviving class of the following order of classes of beneficiaries deemed named by the Employee:

The deceased Employee’s

  1. Widow or widower;
  2. Surviving legitimate, legitimated, legally adopted and recognized natural children;
  3. Surviving illegitimate children without distinction;
  4. Surviving parents;
  5. Surviving brothers and sisters of the full blood;
  6. Surviving brothers and sisters of the half-blood; or
  7. executors, administrators or assigns.

If two or more beneficiaries belong to the same class entitled to the insurance proceeds, such beneficiaries shall share equally. Any minor’s share shall be paid in the manner provided by law.

Any such payment shall discharge Sun Life Philippines to the extent of the amount paid.

NOTE:   

The above are standard requirements, additional documents may be required as the claim is appraised.    

If the claimant wishes us to return the original or certified true copies of documents, please submit also a photocopy of such documents.   We shall authenticate the photocopy against the original or certified true copy before we return the latter to the claimant.

 

Download File

Motor Claim

CONTACT: +63 917 595 6840 / [email protected]

Documentary Requirements:

Own-Damage Claim

  • Police Report or Affidavit of Accident
  • Photocopy of Certificate of Registration with latest Official Receipt
  • Photocopy of Driver’s License with corresponding Official Receipt
  • Repair Estimate (from accredited Repair Shops)
  • Pictures of the damaged portion of the vehicle
  • Stencil of chassis and motor number

Third Party Property Damage Claim

  • Police Report or Affidavit of Accident
  • Photocopy of Certificate of Registration with latest Official Receipt
  • Photocopy of Driver’s License with corresponding Official Receipt
  • Repair Estimate (from accredited Repair Shops)
  • Pictures of the damaged portion of the vehicle
  • Certificate of No-claim

Third Party Bodily Injury Claim

  • Police Report or Affidavit of Accident
  • Original Medical Certificate
  • Original official receipts pertaining to medication
  • Death Certificate