Make a Claim

This guideline seeks to promote greater fairness and transparency between you, the client and us, your insurers. Please be advised that we will handle all claims fairly, promptly, efficiently and in accordance with the terms of the insurance contract and company policy. Timely and accurate information should be provided to the insurer at all times.

ALL DOCUMENTS MUST BE ORIGINALS

POLICYHOLDER'S / CLAIMANT'S RESPONSIBILITY

To notify us by means of a written document, telephone, email or face to face contact and subsequently submitting a completed claim form to us at any of our locations in keeping with policy conditions. If there is an agent or broker involved they should forward the completed claim form to us within three (3) business days from the date of receipt of the claim form.
To cooperate in the investigation by providing the insurer with all relevant information and documents (see overleaf) to ensure timely processing of your claim.
Payment of your deductible.
Once an agreement has been reached and payment effected, a copy of the signed release must be submitted to us.
All writs, summons and/or any legal documents must be reported to Algico / Alico immediately.

THE INSURER'S RESPONSIBILITY

We would acknowledge receipt of the claim form within two (2) business days and advise of all documents required and whether an independent adjuster or investigator should be appointed.
We should appoint an investigator/adjuster within two (2) business days from the date we receive the completed claim form.
If it is determined that the claim is not covered by the insurance contract, we will notify you in writing, stating the policy Provisions, conditions or exclusions.
We would disclose to you the basis used in our offer of settlement. Once an agreement has been reached on the amount of the claim we will effect payment within three (3) business days.
Should there be any delays we would inform you of the status and provide explanations.
In the event of a claim being fraudulent we reserve the right to deny all benefits.

Death Claims

Completed Claimant’s Statement (CL-1) Form (to be completed by each beneficiary/executor/administrator)
Physician’s Statement (CL-2) Form (to be completed by attending physician at death)
Completed Group Claimant’s Statement (CL-4) Form (if its a Group Policy)
Coroner’s Inquest (If Accidental Death)
Original Death Certificate
Proof of age of the Deceased (ID/PP/DP)
Valid Form of Picture ID of each claimant (ID/PP/DP)
Policy Document/Contract/Group Certificate/Endorsement
Application for ‘Lost Policy Form’ (if policy is lost)
Letters of Administration (provided there is no named beneficiary)
Release of Assignment (if Policy was assigned to a financial institution)
Stop Deduction Letter (if payment is by Banker’s Order)
Declaration if Claimant is a citizen of the UNITED STATES
An Affidavit completed by someone other than the beneficiary would be required if the name is different due to spelling on the Policy Contract and the ID presented.
Original Marriage Certificate of the beneficiary if the beneficiary named on the Policy Contract was changed due to Marriage.

Disability / Dismemberment Claim

Written notification within 30 days of incurred date
Completed Claimant’s Statement (CL-20) Form - Dismemberment (to be completed by the claimant/insured)
Physician’s Statement (CL-108) Form - Disability
(to be completed, signed and stamped by the Attending Physician)
Completed Employer’s Statement (CL-107) Form (to be completed and signed by Employer)
Valid Form of Picture ID of each claimant (ID/PP/DP)
Original Medical Bills/Sick Leave certificates if required
The written results of Medical Test Reports (XRay, MRI, CAT Scan, etc as necessary
Declaration if Claimant is a citizen of the UNITED STATES
Medical Certificate of Fitness

Medical / Surgical Expenses

Written notification within 30 days of incurred date
Physician’s Statement (CL-108) Form - Disability
(to be completed, signed and stamped by Attending Physician)
Completed Employer’s Statement (CL-107) Form
(to be completed, signed and stamped by Employer)
Valid Form of Picture ID of each claimant (ID/PP/DP)
Original Medical Bills/Sick Leave certificates if required
The written results of Medical Test Reports (XRay, MRI, CAT Scan, etc as necessary
Declaration if Claimant is a citizen of the UNITED STATES
Medical Certificate of Fitness

Critical Illness

Written notification within 30 days of incurred date.
Physician’s Statement (CL-108) Form - Disability
(to be completed, signed and stamped by Attending Physician)
Completed Employer’s Statement (CL-107) Form
(to be completed, signed and stamped by Employer)
Valid Form of Picture ID of each claimant (ID/PP/DP)
Original Medical Bills/Sick Leave certificates if required
The written results of Medical Test Reports (XRay, MRI, CAT Scan, etc as necessary
Declaration if Claimant is a citizen of the UNITED STATES
Medical Certificate of Fitness