Allianz Claims. The complete guide about your insurance claims. With you from A-Z ALLIANZ MALAYSIA

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1 ALLIANZ MALAYSIA Allianz Claims The complete guide about your insurance claims With you from A-Z Allianz General Insurance Company (Malaysia) Berhad Suite 3A-15, Level 15, Block 3A, Plaza Sentral, Jalan Stesen Sentral 5, Kuala Lumpur Sentral, Kuala Lumpur Tel: / Fax:

2 Contents ALLIANZ CLAIMS CONTACTS 1 ALLIANZ MISSION 23 CONTACT DETAILS GENERAL INSURANCE ALLIANZ CLAIMS CHARTER CLAIMS PROCEDURE MOTOR CLAIMS NON MOTOR CLAIMS LIFE INSURANCE CLAIMS PROCESS INDIVIDUAL LIFE GROUP LIFE ALLIANZ MEDICAL CARD

3 1 Allianz Vision To be the most reliable partner, always delivering in moments of truth Allianz Mission Insurance solutions from A-Z

4 2 General Insurance Claims MIssion Fast and Fair solutions in your hour of need Poopak Setoodehnia, Allianz customer since 2010

5 Allianz's Claims Charter 3 Motor Repair Approval Within 7 days Replace Damaged Windscreen Without Paying Motor Theft Approval Within 60 days 96 Hours Claims Settlement For Non Motor Claims Below RM3, Days Claims Settlement For Non Motor Claims Below RM20, Days Claims Settlement For Non Motor Claims Below RM50,000 Payment Exceeding RM1 Million To Be Made Within 7 Days Interim Payment Consideration

6 Claims Procedure 4 96 hours claims settlement for an amount of less than RM3,000 for non motor claims excluding Fidelity Guarantee, Marine and Liability claims procedure Insured submit full claims documents Allianz process and assess the claim Allianz issues cheque The turnaround time from date of receipt of full documents till date of payment is 96 hours. Fast Track claims for an amount less than RM20,000 for non motor own property claims excluding CAR/Eng, Fidelity Guarantee, Marine and Liability claims procedure Insured report claim Allianz appoint adjusters Adjuster contact Insured to make appointment for inspection/ investigation Adjusters assess loss with document from Insured Allianz issues cheque Allianz receive report with said letter Adjusters submit report together with letter from Insured agreeing to the amount Adjusters discuss on an amount acceptable to Insured The turnaround time from date of notification till date of payment is 23 days. Fast Track claims for an amount less than RM50,000 for non motor own property claims excluding CAR/Eng, Fidelity Guarantee, Marine and Liability claims procedure Insured report claim Allianz appoint adjusters Adjuster contact Insured to make appointment for inspection/ investigation Adjusters assess loss with document from Insured Allianz issues cheque Allianz receive report with said letter Adjusters submit report together with letter from Insured agreeing to the amount Adjusters discuss on an amount acceptable to Insured The turnaround time from date of notification till date of payment is 35 days.

7 Claims Procedure 5 Motor own damage claims procedure Notification Allianz appoint adjuster Allianz received adjusters report & claim documents are in order Allianz authorize repairs The turnaround time from notification to authorization is 7 working days SMS Note: Workshop will SMS on the progress of the claim to claimant will be sent Motor theft claims procedure Notification Insured submits complete set of documents Allianz makes offer Allianz issues cheque The turnaround time from notification to offer is 60 days and payment will be made within 7 working days Motor windscreen claims procedure Insured drives to panel workshop Panel workshop repairs / replace the glass Insured drives off after repairs / replacement.

8 Motor Claims 6 Appointment of adjuster within 24 hours. Adjuster reports within 3 days. Authorise repairs from receipt of adjuster's report within 3 days. MOTOR OWN DAMAGE CLAIM SMS SMS to claimant on progress of claim MOTOR WINDSCREEN CLAIM Repair/ Replace at panel workshop with no payment by Insured. Reimbursement upon receipt of complete documents within 3 days. Offer within 60 days. Payment upon acceptance within 7 working days. MOTOR THEFT CLAIM

9 7 Supporting Documents Required For Claims CLASS SUPPORTING DOCUMENTS Windscreen Claims 1. Completed Simplified Claim Form 2. Original Bill 3. Photographs of Damage or Police report Own Damage Theft Total Loss Constructive Total Loss 1. Completed claims form 2. Police Report 3. Registration Card 4. Insured s IC and Driving License 5. Driver s IC and Driving license 6. Road Tax disc 7. Estimate from Workshop 8. Commercial Vehicle Transport Permit 9. Hire Purchase Agreement applicable to Total Loss and Theft claims 10. Copy of Invoice for newly registered vehicle except recond vehicles (applicable to Theft, Total Loss or Constructive Total Loss) OD-KFK 1. Completed claims form 2. Police Report 3. Registration Card 4. Insured s and Driver s IC and Driving License 5. Road Tax disc 6. Estimate from Workshop 7. Police investigations outcome report 8. JPJ extract of Third Party vehicle 9. SD from Insured

10 Non Motor Claims Payment upon receipt of complete documentation within 4 working days CLAIMS LESS THAN RM3,000 EXCEPT FOR FIDELITY GUARANTEE, MARINE & LIABILITY CLAIMS 8 CLAIMS UP TO RM20,000 FOR OWN PROPERTY CLAIM EXCEPT FOR CAR/ENG, FIDELITY GUARANTEE, MARINE & LIABILITY Payment from notification within 23 days Payment from notification within 35 days CLAIMS UP TO RM50,000 FOR OWN PROPERTY CLAIM EXCEPT FOR CAE/ENG, FIDELITY GUARANTEE, MARINE & LIABILITY

11 9 Supporting Documents Required For Claims CLASS SUPPORTING DOCUMENTS Fire Houseowners Householders 1. Police Report 2. Fire Brigade Report 3. Purchase Invoices 4. Quotations for repairs/ replacements 5. Photographs of damage 6. Completed Claim Form 7. Copy of Identity Card for individual or copy of business registration certificate for company Fire Commercial 1. Police Report 2. Fire Brigade Report 3. Completed Claim Form 4. Sales / Purchases Invoices 5. Stock records 6. Business accounts 7. Quotations for repairs/replacements 8. Business license 9. Land titles/tenancy agreements 10. Copy of Identity Card for individual or copy of business registration certificate for company All Risks Burglary Machinery Equipment Engineering 1. Completed Claim Form 2. Police Report if applicable 3. Purchase Invoices 4. Technician s report if applicable 5. Quotation for repairs / replacements 6. Stock records if applicable 7. Photographs of damage 8. Copy of Identity Card for individual or copy of business registration certificate for company

12 10 CLASS SUPPORTING DOCUMENTS Money 1. Completed Claim Form 2. Police Report 3. Receipts / Collection records 4. Banking slips 5. Copy of Identity Card for individual or copy of business registration certificate for company Fidelity Guarantee 1. Completed Claim Form 2. Police Report 3. Copy of appointment letter of defalcator 4. Copy of termination letter to defalcator 5. Internal enquiry of incident 6. Proof of money/stock defalcated 7. Confirmation on the retaining of the defalcator s salaries/monies due to him/her 8. Defalcators personal details 9. Copy of the Identity Card of the Insured if it is an individual or copy of the Insured s company s registration certificate if it a company Workmen s Compensation Local 1. Completed Claim Form 2. Medical Report 3. Medical Certificates 4. Original receipts/bills 5. Three (3) months pay slips prior to accident 6. Motor / Fatal accidents Police reports 7. Fatal claims Post Mortem Report and Death Certificate 8. Copy of the Payee s Identity Card if it is an individual or business registration certificate if it is a company Foreign Workers PD/TTD/ Medical Expenses 1. Labour Assessment Report 2. Laporan Kemalangan (PP2 Form) 3. Medical Report 4. Medical Certificates 5. Original bills and receipts 6. Copy of Passport 7. Copy of Work Permit 8. Letter of employment 9. Three (3) months pay slips prior to incident 10. Police report if applicable

13 11 CLASS SUPPORTING DOCUMENTS Personal Accident Weekly Benefits / Medical Expenses / TTD / PD 1. Completed Claim Form 2. Police Report of applicable 3. Medical Report (not required for claims below RM250.00) 4. Medical Certificate 5. Copy of IC (both sides) 6. Original Bills and Receipts 7. For Group PA salary slips for the past 3 months prior to accident 8. TTP and PD Specialist s reports 9. For Motor accidents driving license Personal Accident Fatal claims 1. Completed Claim Form 2. Police Report 3. Copy of Post Mortem Report 4. Copy of Death Certificate 5. Copy of burial/cremation certificate 6. Letters of Administration if nomination not done 7. Copy of Identity Card of the beneficiary if it is an individual or copy of the business registration certificate if it is a company Hospital & Surgical 1. Completed Claims Form 2. Medical Report 3. Original Bills and Receipts 4. Police Report if applicable 5. Other supporting documents 6. Copy Identity Card if it is an individual or business registration if it a company

14 12 Life Insurance We are there for you - with reliable and fair claims processing when you need us

15 13 How You, As A Claimant Can Assist By providing all necessary and relevant documents in support of your claim within the stipulated timeline in the policy provision.

16 14 Notification of claim Release of Claim Form Claim documents received from clients Check completeness of the documents (checklist) DECISION NO Reject Letter Deferment Advice YES Claim Settlement - Cheque dispatch (Direct to Claimant) - Cheque dispatch through Agency/Broker

17 15 Individual Life CLASS SUPPORTING DOCUMENTSTS Death Claim 1. Claimant s Statement duly completed and signed by the Employer 2. Attending Physician s Statement (Death) 3. Employment Letter 4. Latest Salary Slip 5. Certified copy of Death Certificate 6. Certified copy of Burial Certificate 7. Certified copy of Police Report (if any) 8. Detailed Post Mortem Report (if any) 9. Newspaper Cutting (if any) Note: Certification of documents are to be done by either one of the following: Total and Permanent Disability Claim 1. Claimant s Statement duly completed and signed by the Employer and Employee 2. Attending Physician s Statement (TPD) 3. Employment Letter 4. Latest Salary Slip 5. Diagnostic Report(s) e.g. MRI, X-Ray, HPE, Blood Test, CT Scan, Coronary Angiogram Report, ECG and etc. 6. Police Report (if any) 7. Original Policy Contract 8. Newspaper Cutting (if any) Note: Certification of documents are to be done by either one of the following:

18 16 CLASS SUPPORTING DOCUMENTSTS Critical Illness Claim 1. Claimant s Statement duly completed, and signed by the Employer and Employee 2. Attending Physician s Statement (relevant to the medical condition) 3. Employment Letter 4. Latest Salary Slip 5. Diagnostic Report(s) e.g. MRI, X-Ray, HPE, Blood Test, CT Scan, Coronary Angiogram Report, ECG and etc. Note: Certification of documents are to be done by either one of the following: Hospitalization and Surgical Claim 1. Claimant s Statement duly completed and signed by the Employer and Employee 2. Medical Report 3. Diagnostic Report(s) e.g. MRI, X-Ray, HPE, Blood Test, CT Scan, Coronary Angiogram Report, ECG and etc. 4. Original hospital bill(s) 5. Original official receipt(s) Note: Certification of documents are to be done by either one of the following: Partial Permanent Disability (PPD) Claim 1. Claimant s Statement duly completedand signed by the Employer and Employee 2. Attending Physician s Statement (PPD) 3. Employment Letter 4. Latest Salary Slip 5. Diagnostic Report(s) e.g. MRI, X-Ray, HPE, Blood Test, CT Scan, Coronary Angiogram Report, ECG and etc. 6. Police Report (if any) 7. Newspaper Cutting (if any) Note: Certification of documents are to be done by either one of the following:

19 17 CLASS SUPPORTING DOCUMENTSTS Accidental Medical Reimbursement 1. Claimant s Statement duly completed, witnessed and signed by Life Assured 2. Medical Report (PA) 3. Identity Card duly certified 4. Original hospital bill(s) 5. Original official receipt(s) Note: Certification of documents are to be done by either one of the following:

20 18 Group Life CLASS SUPPORTING DOCUMENTSTS Group Hospitalization & Surgical Claim (GHS) from Hospital (Reimbursement) 1. Claim Form duly completed 2. Medical Report (GHS) 3. Original medical bill(s) 4. Original official receipt(s) Group Term Life (GTL) - Death Claim 1. Claimant s Statement 2. Attending Physician s Statement (Death) 3. Employment Letter 4. Latest Salary Slip 5. Certified copy of Death Certificate 6. Certified copy of Police Report for accidental case Note: Certification of documents are to be done by either one of the following: Group Term Life (GTL) Total Permanent Disability Claim 1. Claimant s Statement 2. Attending Physician s Statement (TPD) 3. Employment Letter 4. Latest Salary Slip 5. Diagnostic Report(s) e.g. MRI, X-Ray, HPE, Blood Test, CT Scan, Coronary Angiogram Report, ECG and etc. 6. Police Report (if any) 7. Newspaper Cutting (if any) Group Term Life (GTL) Critical Illness Claim 1. Claimant s Statement 2. Attending Physician s Statement (relevant to the medical condition) 3. Employment Letter 4. Latest Salary Slip 5. Diagnostic Report(s) e.g. MRI, X-Ray, HPE, Blood Test, CT Scan, Coronary Angiogram Report, ECG and etc.

21 19 CLASS SUPPORTING DOCUMENTSTS Group Term Life (GTL) Partial Permanent Disability 1. Claimant s Statement 2. Attending Physician s Statement (PPD) 3. Employment Letter 4. Latest Salary Slip 5. Diagnostic Report(s) e.g. MRI, X-Ray, HPE, Blood Test, CT Scan, Coronary Angiogram Report, ECG and etc. 6. Police Report (if any) 7. Newspaper Cutting (if any)

22 Allianz Medical Card 20 Pre-Admission When to use the Pre-Admission Process? When you have a pre-scheduled surgery or treatment which is at least 3 days ahead of time and on the Doctor s recommendation, we would encourage you to use this pre-admission process. This process eliminates the waiting time for the issuance of Guarantee Letter on the admission day. PATIENT/ INSURED MEMBER SPECIALIST/ HOSPITAL Presents medical card / NRIC / Referral Letter (if any) Doctor perform preliminary medical examination and consultation to determine if admission is required. If admission is required, patient is to sign the Pre-Admission Form at the Hospital s Front Admission Counter. Hospital will liaise and make the necessary arrangement with Allianz s Third Party Administrator (TPA) Patient or the person s mobile no. stated on the Pre-Admission Form will also receive a SMS from the TPA on the Guarantee Letter status. Hospital will inform patient of Guarantee Letter status.

23 Allianz Medical Card 21 Admission When to use the Admission Process? When there is an emergency and admission is required On Doctor s recommendation When outpatient treatment is not an option PATIENT/ INSURED MEMBER SPECIALIST/ HOSPITAL Presents medical card / NRIC / Referral Letter (if any) at the Hospital s Front Admission Counter Hospital to arrange with Allianz s Third Party Administrator (TPA) for the issuance of Guaratee Letter (GL) Patient or the person s mobile no. stated on the Pre-Admission Form will receive a SMS from the TPA on the Guarantee Letter status as well. Hospital to inform the Patient when Guarantee Letter is issued. Proceed to admit the Patient If GL is declined, a GL declined letter is issued to the hospital and hospital is to pass this letter to the Patient Patient to be warded for treatment If GL is declined, Patient has to make the necessary arrangement for selfpayment

24 Allianz Medical Card 22 Discharge PATIENT/ INSURED MEMBER SPECIALIST/ HOSPITAL Patient is informed that he/she may be discharged Hospital to consolidate and make billing arrangement. Faxes final bill to TPA Patient or the person s mobile no. stated on the Pre-Admission Form will receive a SMS from the TPA on the final Guarantee Letter status TPA issues final Guarantee Letter and fax to hospital Patient to settle any excess bill payment with the hospital Patient discharges from hospital

25 23 We are here for you in times of need. Call us or visit us at any or these numbers or locations. Head Office Phone: / Customer Service Line Toll Free: Phone: Fax: customer.service@allianz.com.my Feedback and complaints Phone: Fax: complaints.feedback@allianz.com.my Hospital Admission & Discharge Toll Free: (Individual) (Group) Feedback: For more details, please visit our claims website