The purpose of this document is to provide information to the insureds of CiV Hayat Sigorta A.Ş. (the Company) about the procedure to be followed-up as well as about information and documents that shall be demanded, in case of disability of the insured as a result of an accident or disease.
1. Notification and Application for Claim
1.1. When the disability takes place, the insured informs the Company about the occurrence of the risk by calling the phone number - 0 216 633 18 18.
1.2. After this notification, the documents enumerated hereunder shall be completed by the insured and submitted to the Company in order to get the benefit claim evaluated.
Required Documents for the Evaluation of Claim Request:
a) The Disability Claim Payment Request Form, to be filled up and wet-signed by the insured,
b) Photocopy of both sides of the insured’s identity card,
c) If the disability has occurred as a result of an accident, the accident record or incident fact-finding report explaining when and how the accident took place (either the original or its photocopy approved by the issuing authority),
d) If the disability has occurred as a result of a disease, the detailed medical certificate explaining the characteristics of the disease, and when and how and with which complaints it had started (either the original or its photocopy approved by the issuing authority),
e) The Committee Report drawn up by Social Securities Institution or Public Hospital explaining which organ is affected by the disease and the degree thereof (either the original or its photocopy approved by the issuing authority),
f) At the disability claim request evaluation phase, additional information and/or documents may be demanded, if it is required.
2. Evaluation of Claim Request and Decision
2.1. The Company commences to make an evaluation about the payability of the claim as soon as all of the forms and documents requisite for the evaluation of such claim are submitted the Company.
2.2. It scrutinizes the date of disablement, the incident causing disability or the cause of insured’s becoming disabled regarding the General Conditions of Life Insurance and Individual Accident Insurance and also regarding Special Policy Conditions to determine whether such disablement is within the coverage.
2.3. At the end of the evaluation the Company determines the claim amount to be paid to the insured or decides it to be refused and not to be paid in case if the very incident causing the insured’s disability as an exception in the policy and/or in case if the same is not to be covered in accordance with the General Conditions of Life Insurance and Special Policy Conditions.
2.4. If the claim is refused to be paid, the Company sends a written document to the insured explaining the reasons thereof.
3. Payment of Claim
3.1. If it is decided at the end of the evaluation that the claim shall be paid, the Company pays the claim amount mentioned in Article 2.3 to the account number written on the Disability Claim Payment Request Form, within 2 (two) workdays after the completion of the evaluation.