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 application to accidental medical expenses claim.
1. Notification and Application for Claim
1.1. In order to get the claim request evaluated following documents are completed by the insured and submitted to the Company.
Required Documents for the Evaluation of Claim Request:
a) The Accidental Medical Expenses Claim Request Form, to be filled up and wet-signed by the insured,
b) The accident record or accidental fact-finding report (either the original or its photocopy approved by the issuing authority),
c) Medical certificate drawn up by the insured’s physician, explaining the medical treatment held,
d) All analysis and visualisation reports carried out for diagnosis and treatment,
e) Medical prescriptions, medicine coupons and invoices pertaining to payments,
f) Photocopy of both sides of the insured’s identity card,
g) 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 very incident causing treatment costs regarding the Individual Accident Insurance and also regarding Special Policy Conditions to determine whether such benefit is within the coverage.
2.3. At the end of the evaluation the Company determines the amount of the treatment invoices 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 of the refusal.
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 Accidental Medical Expenses Claim Request Form, within 2 (two) workdays after the completion of the evaluation.