Claims

1. REQUIRED DOCUMENTS FOR MEDICAL CLAIMS

A. For Outpatient treatment (OPD):

1. Duly filled in & signed Claim Form
   For Group Health Insurance - All claims to be submitted through the employer and to be duly attested by competent authority. For the Individual Health Insurance- All claims to be submitted/sent directly to the Guardian Life’s head office and to be signed by insured member only.
2. Original money receipt showing the attending physician's detailed charges along with his signature.
3. Original itemized pharmacy bill showing date of purchase, name of patient, quantity and name of drugs along with photocopy of physician's prescription.
4. Original receipt showing charge for each of the Lab test, X-ray Films, and other examinations done and supported by the respective physician's request to undergo examinations and copies of the results of examinations undertaken.

B. For In-patient treatment (IPD):

1. Duly filled in & signed Claim Form
   For Group Health Insurance - All claims to be submitted through the employer and to be duly attested by competent authority. For the Individual Health Insurance- All claims to be submitted/sent directly to the Guardian Life’s head office and to be signed by insured member only.
2. Consultant’s recommendation for hospitalization (attested Photocopy)
3. Discharge certificate (attested photocopy)
4. Original and itemized Bills / Receipts of all relevant expenses i.e. Hosp. Accommodation, medicines, consultation fees, investigations, procedures, Surgery, any medical or surgical items along with their requisition slip. Database bills is preferred.
5. A copy of the patient's file while hospitalized.

C. Important points for claim reimbursement:

1. Submit your claim within allowable limit.
2. Patient’s name has to be same as earlier submitted Health Insurance Application Form. Please avoid use of nick name.
3. All receipt related with financial transection must be original one. Total claim amount must be well supported by submitted supporting documents.
4. Overwriting or writing by self in any claim documents to change the amount is strictly prohibited. Guardian Life reserve rights to decline total claim if it is proven that insured member has manipulated the bills or trying to manipulate the bills.
5. Voluntary collection of manual or computer compose bill instead of Software generated bill where well-functioning system is available also strongly prohibited.
6. The Company shall, where it deems necessary, seek opinion of it’s medical expert to satisfy itself that the Member has been provided with the reasonable medical treatment and services.
7. Guardian Life reserve rights to obtain any information from any source and to verify any claims by independent & professional 3rd party and may call relevant any documents before final settlement.

2. REQUIRED DOCUMENTS FOR DEATH CLAIMS:

1. Duly filled in & signed Claim Form.
   For Group Life/ Credit Shield Insurance - All claims to be submitted through the Employer / Bank or Leasing Company and to be duly attested by competent authority. For the Individual Life Insurance- All claims to be submitted/sent directly to the Guardian Life’s head office and to be signed by valid nominee.
2. Original or attested photocopy of Death Certificate from the Hospital and/or Death Registration Certificate issued by Municipal Body, either from the health department of City Corporation / Local Union Parishad / commissioner / Councillor / Chairman / Mayor (on his/her official printed letterhead).
3. Employment Certificate by the Employer for Group life Insurance, Copy of Loan / Card approval letter including copy of DGH filled out by insured Credit Shield Insurance and Original Policy Document in case of Individual Life Insurance.
4. Copy of National Identification Card (NID) or Smart Card of Deceased and Nominee.
5. Succession report / Nomination certificate for applicable cases
6. Treatment record of Deceased prior death (if any)
7. For accidental or any unnatural death- Copy of FIR/GD, Inquest Report and Post mortem report.
8. Guardian Life reserve rights to obtain any information from any source and to verify any claims by independent & professional 3rd party and may call relevant any documents before final settlement.

3. REQUIRED DOCUMENTS FOR CRITICLE ILLNESS (CI) CLAIMS:

1. Duly filled in & signed Claim Form.
   For Group Insurance - All claims to be submitted through the Employer and to be duly attested by competent authority. For the Individual Insurance- All claims to be submitted/sent directly to the Guardian Life’s head office and to be signed by Insured Member
2. Employment Certificate by the Employer for Group Insurance and Copy of Policy Document in case of Individual Insurance.
3. Copy of Medical record with detailing of the Critical Illness by the respective specialist physician
4. Copy of medical investigations repot to support or proof the Illness.

4. REQUIRED DOCUMENTS FOR ACCEDENTAL PPD/PTD CLAIMS:

1. Duly filled in & signed Claim Form.
   For Group Insurance - All claims to be submitted through the Employer and to be duly attested by competent authority. For the Individual Insurance- All claims to be submitted/sent directly to the Guardian Life’s head office and to be signed by Insured Member
2. Employment Certificate by the Employer for Group Insurance and Copy of Policy Document for PPD & Original Policy Document for PTD in case of Individual Insurance.
3. Copy of Medical record with detailing of the Disability by the respective specialist physician
4. Copy of medical investigations repot to support or proof the Disability.
5. Proof documents where reflecting the said Disability prevents the insured member from engaging in any business, occupation or work whatsoever for remuneration or profit has continued uninterruptedly for a period of at least six months (for PTD)
6. Original Certificate from respective specialist physician as a proof of irrecoverable condition, dated after initial six month (for PTD)
7. Guardian Life reserve rights to obtain any information from any source and to verify any claims by independent & professional 3rd party and may call relevant any documents before final settlement.

IMPORTANT POINTS FOR DEATH / CI / PPD / PTD CLAIMS:

1. Submit your claim within allowable limit.
2. Name of claimant has to be same as earlier submitted documents. Please avoid use of nick name.
3. Overwriting or writing by self in any claim documents is strictly prohibited. Guardian Life reserve rights to decline total claim if it is proven that insured member has manipulated the claim documents or trying to manipulate the claim documents.
4. The Company shall, where it deems necessary, seek opinion of it’s medical expert along with the Company’s appointed physician to satisfy itself that cause of death or disability mentioned in submitted documents are justified.
5. Guardian Life reserve rights to obtain any information from any source and to verify any claims by independent & professional 3rd party and may call relevant any documents before final settlement.