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 What are the requirements in filing an AD&D Benefit claim?


When filing an AD&D benefit claim, please submit the following:


1.     Accident Claim Form 

2.     Attending Physician’s Statement 

3.     Medical Abstract / Admitting History, if applicable 

4.     Official receipt and statement of account 

5.     Operation Room Record, if applicable  

6.     Statement from Identifying Witness, if applicable 

7.     Police or NBI Report, if applicable 

8.     Autopsy report, if applicable (if cause of death is accidental or violent death) 

9.     Criminal complaint/fiscal’s resolution (if cause of death is accidental or violent death) 

10.  Photocopy of two (2) claimant’s valid/government issued ID (photo bearing with 3 specimen signatures) 


Note: Additional documents will be required in view of certain information revealed during the review of the claim. The release of the forms does not mean that the insurance coverage is in force with respect to the employee and that there is a valid claim under the group policy. 

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