Make a Claim

Surgical, Accident Medical Reimbursement, Medical Expenses Coverage

• A Detailed medical report. This must be completed and signed by you and your treating physician.
• Your original hospital bill and emergency ambulance bill (if applicable).
• Your original hospital receipt. (This is the proof of payment based on the bill issued).
• A copy of your medical report detailing your ailment or accident and the date it started/happened.
• A copy of all relevant X-Rays / Echography / MRIs and reports. These should show your name and the date they were taken.
• A copy of all lab tests and reports related to this incident.
• A copy of the Police Report (if your claim relates to an accident).
• A copy of your passport showing dates of exit and entry (if the incident occurred outside your country of residence).

• A notification of the death of the policyholder. This must include the full name of the Insured (including father’s name), policy number, date of death, cause of death, and any other information that may be relevant to this claim, for example, names of hospitals and doctors involved.
• Claimant's Statement. Each beneficiary should complete a separate claimant’s statement. In the case of minor beneficiaries, the guardian must sign the claimant’s statement on their behalf. Each form must be notarised by a Notary Public or signed in front of the MetLife Alico Claims Manager.
• Claim Form. This form should be completed by the Physician who treated the insured during their last illness.
• A detailed medical report related to this claim.
• A copy of the passport of the deceased and copies of passports or ID Cards of the beneficiaries.
• The original Death Certificate.
• The Original Guardianship / Tutorship Certificate issued by court and specifying the powers given to the guardian or tutor whenever there are minors among the beneficiaries. The claim can only be paid to the guardian or tutor entitled by law or order of court to “cash proceeds and give valid discharge”.
• The Original Succession Certificate. This is required in cases where the names of the beneficiaries are not specified or when beneficiaries are mentioned as “legal heirs”.
• The Original Policy Document. The Terms and Conditions, after the death of the Insured, state that the contract terminates and policy contract must be returned to us.
• A copy of the Police Report (if death was a result of accident or murder or whenever a report is made specifically in connection with a certain death).
• The Post Mortem / Autopsy or Coroner’s Report.
• The exact addresses and telephone numbers of all beneficiaries.
• Newspaper clipping (if applicable).

Additionally if the deceased was a group policy holder:

• A Letter from employer stating the date of last day the deceased reported to their office on a full time basis as well as the date when the deceased’s contract was ended by the company.
• A Salary slip showing the last monthly basic salary drawn by late Insured.

In certain cases, we may contact the beneficiaries and request further documents.

Accident Income or Weekly Income Coverage

• A Detailed medical report (Preliminary Report) should be provided with claim notification, only if disability is expected to surpass 6 weeks.
• Claim form (Final Proof of Loss) should follow the detail medical report at the end of disability period or should be provided if your disability period is not to exceed 6 weeks. Please ensure that the dates used reflect the actual period in question as it will not be possible, under any circumstances, to extend the disability period beyond this date.
• Claim form (Employer's Statement) to be submitted at the end of the disability period.
• A copy of all relevant X-Rays / Lab Test and reports. These should show your name and the date they were taken.
• A copy of the Police Report (if applicable).
• A copy of your Physician’s Statement (P.S) or the medical report detailing the nature and date of the accident.

• Claim form (Claimant Statement) and (Physician Statement) (for Total disability) or (for Partial disability). This must be completed and signed by you and your treating physician.
• A copy of all relevant X-Rays / Lab Test and reports. These should show your name and the date they were taken.
• A copy of your Physician’s Statement (P.S) or the medical report detailing the nature and date of the accident.
• Regular medical reports providing status on the disability (if you are eligible for waved premium benefit). In certain cases, we may also need you to attend a medical examination or provide more details requested through a doctor or a medical committee. If this applies in your case, we will let you know.
• A copy of the Police Report (if your claim relates to an accident).

Hospitalisation and you hold In Hospital & Surgical Policy

• A Detailed medical report. This must be completed and signed by you and your treating physician.
• A copy of your Physician’s Statement (P.S) or a medical report detailing the nature and date of the onset of the ailment / accident as well as the nature of the surgery.
• A certified copy of your hospital bill or a discharge summary to determine the number of days spent in hospital.
• In certain cases, we may request a copy of all the relevant medical reports. These should show your name and the date they were written.
• A copy of the Police Report (if your claim relates to an accident).

Recovery Benefit Plan/Critical Care Coverage

• A Recovery Benefit Plan claim form.
• A copy of your Physician’s Statement (P.S) or a medical report detailing the nature and date of the onset of the ailment as well as a history of risk factors (your P.S will advise on these).
• A copy of your medical report.
• A copy of all relevant Pathology reports/ Lab tests / X-Rays / MRIs or CT Scans. These should show your name and the date they were taken.
• In certain cases, we may request a copy of other documents. If this applies in your case, we will let you know.

• Claim form (Claimant's Statement). This must be completed and signed by you and your Treating Physician.
• A copy of all relevant X-Rays / Lab Test and reports. These should show your name and the date they were taken.
• A copy of your passport showing dates of exit and entry (if the incident occurred outside your country of residence).
• Your original bills and receipts related to this claim.
• A copy of your medical report from your Treating Physician indicating the nature and date of onset of ailment / accident as well as the degree of disability.

• Claimant’s Statement. Each beneficiary should complete a separate claimant’s statement.
• Claim form. This form should be completed by the Physician who treated the Insured during their last illness.
• A detailed medical report related to this claim.
• The Original Death Certificate.
• A copy of the passport of the deceased and copies of passports or ID Cards of the beneficiaries.
• The Original bills / receipts related to this claim.

• In-Patient/Medical Reimbursement claim form properly completed and signed by you and your Treating Physician.
• Your detailed medical report indicating the nature and the date of the onset of the ailment or accident.
• All your original pharmacy bills and receipts of usual /customary and reasonable medical expenses incurred along with a Doctor’s prescription.
• A copy of your passport showing dates of exit and entry (if the incident occurred outside your country of residence).
• Additionally for Emergency dental Expenses claim
• X-Ray films taken immediately after the accident and before commencement of any treatment.