Dear Colleagues All RHRS – FOS are covered under Group ...

Dear Colleagues, All RHRS – FOS are covered under Group Personal Accident Insurance (GPAI). Find below the details of this policy. Please read the details given carefully and make use of this opportunity to its maximum. Following the guidelines for submitting the completed documents within the time line, will help us to serve you better and timely disbursement of claim payments. 1. Find below the details of policy ¾ GPAI policy number -1111332914000028 ¾ Policy Period - 26th September-13 to 25th Septemebr-14. ¾ Policy holder - Reliance HR Services Pvt. Ltd, DAKC, Navi Mumbai. 2. Claim Process. a. All accidents are to be registered with Reliance General Insurance Company (RGI) immediately within 48 hours of accident. Registration to be done via National Toll Free telephone number of the RGI Call Center i.e.180030028282. b. Detailed mail intimation on the accident of employee should be marked to respective circle HR Team. c. Submission of completed Claim form along with original documents, as per the attached list, should be submitted to Respective Circle RHRS HR within 30 days of discharge from hospital. In case of death The Complete documents should be submitted within 50 days of the accident

d. On submission of completed claim documents, the insurance company will release the payments, as per the terms and conditions of the policy within 60 Days of submission. e. In case of death, the claimant needs to submit indemnity bond of the legal heir of the deceased. In case of married employee, indemnity bond is to be provided of his wife, else his mother, else his father.

f. In case of death, reimbursement will be release in the form of cheque and the claimant needs to acknowledge the receipt of payment and the acknowledgement copy to be forwarded to DAKC.

g. In case of accident, reimbursement will be release in the form of direct transfer the claim amount to respective employee’s bank account. 3. Terms & conditions of policy. a. b. c. d. e.

Policy covers only employee and no family members. Policy covers Medical treatment out accident only. Medical treatment expenses up to 1.25 lac. Death coverage up to 2 lac. 24 hours hospitalisation is mandatory for medical expense claim.

GPAI CLAIMS CHECKLIST List of documents: Following documents are required for processing of claim in respect of the accident leading to:

Temporary Total Disability A. B. C. D. E. F. G. H. I. J. K.

Claim Form – fully filled up detailing accident, and injuries, etc. Policy copy Leave certificate from the Employer Medical fitness certificate Medical treatment papers ,discharge card, hospital bill with receipts, (originals required to provide medical extension benefit) Investigation reports, X-ray reports with films, MRI, CT SCAN... reports films. ID proof ,employee id, pan card Salary slips prior to the date of loss. Follow-up consultation papers, till the insured resumes work Driving licence FIR/MLC / Panchnama copy.

Death Claims A. B. C. D. E. F. G. H. I. J. K. L. M. N.

Claim Form – fully filled up detailing accident, and injuries, etc. Policy copy Death certificate Post Mortem Report Viscera report if required in case of opinion of death is reserved for confirmation of death Medical treatment papers if any ID proof ,employee id, pan card Salary slip prior to the date of loss FIR/MLC/ police panchanama Follow-up consultation papers, indoor case papers. nominee id proof Nominee bank passbook details. Any other claim documents on need basis Driving licence

Permanent Disablement Claims: A. Claim Form – fully filled up detailing accident, and injuries, etc. B. Leave certificate from the Employer C. Disability certificate on page no 3 of claim form duly signed and stamped by Civil surgeon D. Medical treatment papers ,discharge card, hospital bills,(originals required to provide medical extension benefit) E. Investigation reports, x-ray reports with films, MRI, CT SCAN... reports films. F. ID proof ,employee id, pan card G. Salary slip prior to the date of loss H. FIR/MLC/Panchnama I. Follow-up consultation papers, indoor case papers J. Driving licence K. Photographs of disabled/amputed/lost part of the insured. L. Policy copy