Annexure 3
CLAIM INTIMATION AND SUBMISSION PROCEDURE
UNITED INDIA INSURANCE CO. LTD (UIIC)
Group Personal Accident Policy for “Salary Package Account Holders of State Bank of India”
UIIC Policy No. 1203004218P113494902 Policy period- 04.01.2019 to 03.01.2020
(A) CLAIM PROCESS
1. The claim process consists of 2 stages:
(a) Intimation of the Death to UIIC
(b) Submission of the Claim Form & other documents to UIIC
2. In the event of death of the Salary Package account holder, an intimation as per
Annexure 4 is to be given by the claimant to UIIC within 90 days of the death.
The timely claim intimation of death is mandatory and to be sent to the following
address:
United India Insurance Co. Ltd
Divisional Office–XI, Maker Bhavan No.1,1st floor, Sir V.T. Marg,
Mumbai – 400020.
Fax No.: 022-22624579
Land Line Number- 022- 22624525/22624818
EmailId:120300@[Link]/ vtsangtani@[Link]
3. The intimation can also be given through the following channels :
(Applicable both in case of Death and Disbality)
(a) Fax No. 022 – 22624579 (As per Annexure 4) or
(b) Email ID: 120300@[Link]/ vtsangtani@[Link] (As per Annexure 4)
The following details are to be provided:
i. Name of the deceased Salary Package Account Holder
ii. SBI Salary Package Account No.
iii. Date of Accident
iv. Date of Death
v. Place of accident
vi. Details of accident
vii. Name of the Claimant, their Mobile No. and Email ID
viii. Name of the SBI Branch and their Code No.
ix. Name of the organization in case of DSP / PMSP / ICGSP (Army / Air
Force / Navy / Indian Coast Guard/ Assam Rifle / Rashtriya Rifle / BRO
(GREF) / BSF / CRPF / CISF / ITBP/ SSB / NSG)
x. Personal/ Force number (for DSP, PMSP account holders)
4. Immediately on registering the claim as mentioned above, a system generated
reference number would be advised to the claimants by UIIC.
5. The claimant shall submit the following claim documents to UIIC Mumbai Office
(Address mentioned under Para-2 above), within 90 days after intimation of
death:
i) Personal Accidental & Air Accidental Insurance (death) claim:
a) Completely filled Claim Form duly signed by the claimant, as per Annexure 5.
b) Attested copy of Police F.I.R (For Armed forces: Defence Authority report in
case FIR is not available)
c) Copy of Post Mortem Report.
d) Copy of Death Certificate.
e) Branch Manager Certificate on Bank letter head, as per Annexure 6.
f) PAN card copy of the Claimant. If not available, then Form 60 to be submitted.
g) Original Cancelled Cheque of Bank Account in the Name of the Claimant / or
Photocopy of the first page of the Bank Passbook containing the Name of
Account Holder, Bank Account Number, IFSC Code.
h) NEFT form of claimant as per Annexure 7, certified by claimant’s Bank, for the
purpose of payment in respect of settlement of claim.
i) Other suitable documents to prove legal heirship in case claimant is not a
nominee/ joint account holder as per Bank’s record. In case of multiple heirs,
consent form.
j) For Air Accident: Bank statement indicating purchase of Air ticket using SBI
Debit card/ Internet Banking.
k) Viscera Report/chemical analysis report in case where post mortem report
shows the cause of death is poisoning or alcohol or any substance abuse.
l) Aadhar Card of the claimant.
ii) Disability Claims (only the undernoted four forms are required)
a. intimation as per Annexure 4
b. Claim form as per annexure 9
c. Medical Certificate as per annexure 10
d. Branch Crtificate as per annexure 11
ii) Additional documents for add on cover (Accidental Death)
In addition to documents applicable for submission of PAI claims, undernoted
Certificates/ documents are also required:
i. Cost of Plastic Surgery / Burn (only for Gold, Diamond, Platinum)
a. Treating doctor’s/ Surgeon Certificate
b. Original Discharge Summary containing all relevant details.
c. All original bills and their receipts.
d. Copies of all reports and prescriptions.
e. First prescription/ consultation letter from the Doctor.
f. Original Money Receipt duly signed with revenue stamp.
ii. Transportation of Imported Medicine (only for Gold, Diamond, Platinum)
a. Medical Practitioner’s prescription.
b. Copy of medicine invoice.
c. Invoice copy of freight expenses mentioning details of medicine imported,
country of origin from which it is being imported, date and price of the
medicine and freight expenses.
iii. Death after Coma after accident (more than 24 hrs)-
Medial certificate mentioning the duration of coma (start and end of coma
period) supported by discharge summary and indoor case papers.
iv. Air Ambulance
a. Attending Doctor’s advice/ note with reason for shifting of the patient.
b. Original invoice and receipt for the Air Ambulance mentioning date of
travel, sector (from/ to place) and total amount.
v. Higher Education Cover for child (only Graduation)
Copy of admission confirmation and certificate from educational institute
stating details of full time course in a recognized college in India for
Graduation along with duration of course and date of enrollment.
vi. Girl child marriage: Marriage expenses: (18-25 age)
a. Birth certificate/ Date of birth proof of girl child.
b. Document showing relationship with deceased Salary Account holder.
vii. Family Transportation:- (Travelling cost incurred by immediate 2 family
members to reach place of accident)
a. Original bill, receipt and travel ticket showing date of travel, Sector (from/
to) and amount incurred.
b. Copy of proof of the immediate family member such as Ration Card.
viii. Repatriation of mortal remains:-
Original Bill and receipt for transport of mortal remains, showing date and
sector (From/to)
ix. Ambulance charge
All related original bills and their receipts.
6. Claimant will submit the Claim Form completed in all respects, with relevant
documents mentioned under Para 5 above, directly to UIIC. The system
generated Claim Number/ Salary Account No. should be mentioned on the
Claim Form while sending the physical documents. The Claim No. can be
used for any queries/further follow up with the UIIC claim department.
7. However, in case, the claim application is received by the SBI Bank Branch
having the Salary Account, it shall be forwarded to UIIC Mumbai Office (Address
in Para 2) along with a detailed covering letter.
8. The total period for intimation and claim submission is 180 days maximum
i.e. period for intimation + claim submission = 90 + 90 = 180 maximum
(from date of death).
9. UIIC will settle claims independently without the involvement of the Bank.
10. Subsequent correspondence shall be between the claimant and UIIC.
11. All claims shall be entertained by UIIC where accident has occurred within the
period of policy and death has occurred:
a) within the period of policy or
b) within 12 months of date of accident, in event where death occurs after the
expiry of policy.
B) SETTLEMENT PROCESS and CONTACT DETAILS
1. On receipt of complete set of documents, UIIC will process the claim. Any further
requirement/ deficiencies in the documents submitted shall be sought by UIIC
within 10 working days of receipt of the claim.
2. All the documents being in order, UIIC will settle the claim within 15 working days
from the date of receipt.
3. All the correspondences related to claim will be directly taken up by UIIC with the
claimant. Branch can be a facilitator.
4. All the settlement/ disputes will be between the claimant and UIIC.
5. UIIC will settle claims independently and the claim settlement will be entirely the
responsibility of UIIC. Bank will have no liability towards any claim/ dispute
between the claimant and UIIC.
6. In case of any delay UIIC shall pay interest as per IRDA Norms.
Annexure 3 A
CONTACT DETAILS AND ESCALATION MATRIX
UNITED INDIA INSURANCE CO. LTD(UIIC)
Any communications for correspondence regarding claims should be sent to:
United India Insurance Co. Ltd
Divisional Office–XI, Maker Bhavan No.1,1st floor, Sir V.T. Marg,
Mumbai–400020. Fax No. :022-22624579 EmailId:120300@[Link]/
vtsangtani@[Link]
Status of the claims can be sought, using system generated claim number/ Account
Number, by any of the following channels. :
Sr. No. Channel Details
1 Email ID 120300@[Link]/ vtsangtani@[Link]
2 Land Line Number 022- 22624525/22624818
3 Fax No. 022-22624579
All documents to be forwarded to the Address mentioned below
United India Insurance Co. Ltd
Divisional Office–XI, Maker Bhavan No.1,1st floor, Sir V.T. Marg, Mumbai–
400020.
Email ID: 120300@[Link]/ vtsangtani@[Link]
Escalation Matrix (UIIC) - Contact Details
Escalation Level Designation Telephone
1st Escalation Administrative Officer 8108145679
nd
2 Escalation Assistant Manager 7507900037
rd
3 Escalation Divisional Manager 9730228022
Assistance can also be availed from Anand Rathi Insurance Brokers Ltd (ARIBL) for knowing the
status of claims as well as resolution of grievance. Contact details of ARIBL are as under:
Sr.
Channel Details
No.
Name Anand Rathi Insurance Brokers Ltd.
Contact Bhupendra Thanekar, Manager (Corporate General
1
Person Insurance)
2 Telephone 022-4909 3006,
3 Mobile 9833784147
4 Toll Free No 1800-123-8733
5 Email paihelpdesk@[Link]
Anand Rathi Insurance Brokers Lt. (ARIBL), Regent
6 Letter Chambers, 10th Floor, Jamnalal Bajaj Marg, NarimanPoint,
Mumbai 400021
Annexure 3 B
GRIEVANCE REDRESSAL MECHANISM
Escalation Level 1
(i) The Company is committed to extend the best possible services to its customers.
However, if you are not satisfied with our services and wish to lodge a complaint you
can fill the online form or you may email to the customer service desk at
120300@[Link].
(ii) After investigating the matter internally and subsequent closure, we will send our
response within a period of 15 days from the date of receipt of the complaint by the
Company or its office in Churhgate, Mumbai In case the resolution is likely to take
longer time, we will inform you of the same through an interim reply.
Escalation Level 2
(i) For lack of a response or if the resolution still does not meet your expectations, you
can write to the Head - Customer Services at vtsangtani@[Link]
(ii)After examining the matter, we will send you our final response within a period of 14
days from the date of receipt of your complaint on this email id.
Escalation Level 3
Within 30 days of lodging a complaint with us, if you do not get a satisfactory response
from us and you wish to pursue other avenues for redressal of grievances, you may
approach the Insurance Regulatory & Development Authority (IRDA) or the
Insurance Ombudsman, whose details are given below:
Insurance Regulatory & Development Authority
United India Tower, 9th floor, 3-5-817/818, Basheerbagh,
Hyderabad- 500 029.
Contact Number: 040-66514888
Email ID: [Link]@[Link]
Toll Free Number: 155255
Email ID: complaints@[Link]
a) It has been decided to engage the services of ARIBL for expeditious resolution of any
grievance. Moreover, UIIC has agreed that no claim will be rejected unless it is
decided in the bipartite meeting between them and ARIBL.
b) If the claimant is not satisfied with the Insurer Company’s redressal of his grievance,
through any of the above methods the claimant may approach the nearest Insurance
Ombudsman for resolution of the grievance. The details of Insurance ombudsman are
available on IRDA website: [Link]. The complaint may register his grievance
through IRDA (Insurance Regulatory and Development Authority) online, at
[Link] The guidelines for taking up the complaint with the
Insurance Ombudsman, along with their address are available on the consumer
education website of the IRDA, http: [Link]/[Link]
