Instructions: To begin the claim process, it is necessary to fill out the Claim form for cancer, organ transplant and critical illnesses. [To download the pdf document and print it, go click on]. In addition, you must have available the following documents available, as the case may be:
• Invoice - with diagnosis, of charges for first service received in emergency room or medical consulting office within 72 hours from the accident.
• Surgery invoice, if it was carried out within 60 days after the accident.
• Evaluation sheet from the Emergency Room, if the invoice has no diagnosis.
• State Insurance Fund: If the accident was dealt with by the Fund, Form 1021
(Medical certification) or breakdown of medical services.
• ACAA: If accident was dealt with by ACAA, breakdown of medical services received in ACAA’s Emergency Room.
Note:
All claims must be presented with the corresponding Claim Form duly filled out and signed. The following information is of vital importance.
● Complete and legible postal address.
● Social Security of the person paying for the policies.
All the invoices must include the date of the incurrence, must be duly identified by the provider, medical description and the charge for the services received.
*Please include copy of your last voucher as evidence of the withholding or any other evidence of payment.
IMPORTANT NOTICE
Any person who knowingly and with the intention to defraud presents false information in an insurance application or, who were to present, help or make to present, a fraudulent claim for the payment of a loss or benefit, or were to present more than one claim for the same damage or loss, shall incur in a serious crime and if convicted, shall be sanctioned for each violation with a penalty of a fine no lesser than five thousand (5,000) dollars, nor greater than ten thousand (10,000) dollars or penalty of prison for a fixed term of three (3) years, or both penalties. If there were aggravating circumstances involved, the established prison term may be increased up to a maximum of five (5) years; if there were mitigating circumstances involved, it could be reduced up to a minimum of two (2) years.
