Instructions: To begin the process of claim must fill in Claim Form for continuity of disability. [To download and print a PDF document, click here.] In addition, you must have the following documents available, as the case may be.
● Supporting documentation for the payment of benefits:
→ Claim Form completed:
- At its bottom by the employer.
- At its rear by the treating doctor indicating the period.
→ If heeded by the State Insurance Fund:
- Medical Certification (Form 1021).
- Green Leaf start resting (Form 395).
Note:
A claim must be filed with the Claim Form for duly completed and signed. The following information is of vital importance:
● Full postal address and legible
● Social Security from the person who pays the insurance policy(s)
All invoices should include the date of incurrencia, be properly identified by the supplier, description and medical office for the services received.
* Please include a copy of your last stub as evidence of the discount or other evidence of payment.
IMPORTANT NOTICE
Any person who, knowing the or with the intention to defraud, were to present false information in an insurance application or, who were to present, help or made 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 they were convicted, shall be sanctioned for each violation with a penalty of a fine no lesser than five thousand (5,000) dollars, no 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 to be mitigating circumstances involved, it could be reduced up to a minimum of two (2) years.
