Details required for registration/ Intimation of Claim
To register a claim/seek assistance through the above contact points, the
following information has to be provided:-
The number of the physician
The name and telephone numbers of the hospital at which treatment is being obtained
The fact or matter giving rise to the need for nedical treatment
Reimbursement
Points to Remember
Assistance service provider is to be intimated in the event of any treatment, non intimation
may invalidate the claim.
Cashless will be extended for all in-patient treatments only when service provider is
intimated & pre approval obtained(as per policy T & C)
OPD Claims & claims other then In-Patient will be reimbursed upon return to India.
Policy does not cover traveling abroad for obtaining medical treatment & travelling
against medical advice.
The claim file has to be submitted at the below mentioned addresses within 30 days from after
the date of loss.
Courier AddressStrive Insurance Brokers pvt. ltd.
List of Documents
Personal Accident
Copy of FIR (filed with the local police authorities)
Claim Form (to be filled and signed by insured)
Release of Medical Information Form (ROMIF) BAJAJ and AGA (to be filled and signed by
insured) to obtain the medical records from facility
Medical records/Consultation Papers/Investigation Reports in case any hospitalization
Death certificate/Post Mortem report in case its conducted (In case of Death)
Certificate from Civil surgeon certifying the extent and percentage of disability (For
Disability claims)
NEFT form and Cancelled cheque stating insured's (nominee in case of death claim)
Claimant Indian Bank account details
Passport and Visa copy with Entry Stamp Overseas and exit Stamp from India
Personal Accident
Claim Form (to be filled and signed by insured)
Attending Physician Statement (to be filled and signed by overseas treating doctor)
Release of Medical Information Form (ROMIF) BAJAJ and AGA (to be filled and signed by
insured) to obtain the medical records from facility
Medical records/Consultation Papers/Investigation Reports
Invoices / Bills towards medical expenses.
NEFT Form and Cancelled cheque stating insured’s / Claimant Indian Bank account details
(for reimbursement claim).
Passport and Visa copy with Entry Stamp Overseas and exit Stamp from India.
Deductible amount as per policy schedule to be issued with DD/ Cheque in favour of Bajaj
Allianz General Insurance Company Ltd (in case of complete cashless subject to
confirmation of admissibility from “Us”.) In case inability to provide deductible amount
from insured same can be deducted from your cashless bill.
Medical Evalution
Claim Form (to be filled and signed by insured)
Attending Physician Statement (to be filled and signed by overseas treating doctor)
Release of Medical Information Form (ROMIF) BAJAJ and AGA (to be filled and signed by
insured) to obtain the medical records from facility
Medical records/Consultation Papers/Investigation Reports
Invoices / Bills towards medical expenses.
Original Paid receipts (hardcopy) in case of reimbursement claim.
Form and Cancelled cheque stating insured’s / Claimant Indian Bank account details (for
reimbursement claim).
Passport and Visa copy with Entry Stamp Overseas and exit Stamp from India.
Deductible amount as per policy schedule to be issued with DD/ Cheque in favour of Bajaj
Allianz General Insurance Company Ltd (in case of complete cashless subject to
confirmation of admissibility from “Us”.) In case inability to provide deductible amount
from insured same can be deducted from your cashless bill.
Repartiration
Claim Form (to be filled and signed by assignee)
Invoices / Bills towards medical expenses
Original Paid receipts (hardcopy) in case of reimbursement claim
Death certificate/Post Mortem report/ Certificate of emblem in case its conducted
NEFT Form and Cancelled cheque stating assignee‘s Indian Bank account details (for
reimbursement claim.)