Disability or Dismemberment

• Claim Forms
  For Disability:
  • Part I: Total and Permanent Disability Claim Form (Claimant's Statement)
  • Part II: Total and Permanent Disability Form (attending Physician's report)
  For Dismemberment:
  • Part I: Accident/ Hospitalization Claim Form –(Claimant's Statement)
  • Part II: Accident/Hospitalization Claim Form – (attending Physician's report)
• Attested True Copy of Indoor Case Papers of the Hospital(s).
• Discharge Summary of Present and Past Hospitalizations.
• Medical Examination Certificate (First Consultation Notes) & follow-up Consultation Notes.
• All related Medical Examination Reports, e.g.
  • Laboratory test reports.
  • X-Ray / CT Scan / MRI Reports & Plates.
  • Ultrasonography Report.
  • Histopathology Report.
  • Clinical / Hospital Reports.
  • Angiography Reports & Plates.
  • Others (please specify).
• Clinical Photographs showing the injured areas - if available
• Disability Certificate by attending physician / Institute for disabled
• Rehabilitation Certificate - if applicable.
• Sick Leave certificate - if applicable.
• Employer's written confirmation / statement - for Disability claims

• All police reports / First Information Report & Final Investigation Report - if due to accidental cause.(All Dismemberment claims shall submit proof of accident)
• Reason for delay in intimation.
• Proof of Accident – Panchnama / Inquest report - if due to accidental cause.(All Dismemberment claims shall submit proof of accident)
• Newspaper cutting / Photographs of the accident - if available.(All Dismemberment claims shall submit proof of accident)

• All police reports, PM Report & Chemical Viscera report if performed, Newspaper cuttings if any

Please Note : In addition to above documents requirements, Tata AIA Life reserves the right to ask for more documents/information, medical examination/tests and autopsy as may be required in consideration of the claim

Notifications of claim, submission of claim forms and/or claim documents to the Company shall not be construed as an admission of liabilities of the Company