Oriental Insurance Claim forms and procedure

Oriental Insurance online Claim procedure

1. Visit Oriental Insurance company portal “http://www.orientalinsurance.org.in/”.
2. Login to the portal by entering your Oriental Insurance company User id and password.
3. Click on Claim tab on your personalized homepage.
4. Then you will be able to view Oriental Insurance claim forms. Enter the policy number for which you desire to intimate a claim and fill the claim intimation form.
5. Once submitted, the intimation goes to Oriental Insurance company office in which the policy was underwritten.
6. The online Oriental Insurance claim form intimation only informs Oriental Insurance that a claim has arisen.
7. You can view your intimated Oriental Insurance claim forms through “My Intimated Claims”.
8. Please note that you are required to visit the Oriental Insurance company office to submit the detailed Oriental Insurance claim form and other essential documentary evidence to register the claim with Oriental Insurance.
9. Only when claim is registered with Oriental Insurance company, it will appear on your homepage.

Oriental Insurance policy claims can be made in two different modes

1. Reimbursement Claims Process
2. Cashless Claim Process

Procedure for Reimbursement Claims

Steps to be followed in case of Reimbursement claims:

1. Preliminary notice of claim to be given to the Insurance company.
2. Provide details such as
   • Particulars relating to Policy Number.
   • Name of insured person in respect of whom claim is to be made.
   • Nature of illness/injury.
   • Name and Address of the attending medical practitioner/Hospital/Nursing Home should be given to the Company.
3. TPA within 7 days from the date of hospitalization in respect of reimbursement of claims from time to time.
4. Final claim along with hospital receipted original Bills/Cash memos.
5. Claim form and documents as listed in the claim form should be submitted to the Policy issuing Office/TPA not later than 30 days of discharge from the hospital.
6. The insured may also be required to give the Company/TPA such additional information and assistance as the Company/ TPA may require in dealing with the claim, from time to time.

Procedure for Cashless Claims

Steps to be followed in case of Cashless Claims:

1. Oriental Insurance claim forms in respect of Cashless facility will be through the agreed list of Network Hospital / Nursing Home / Day Care Centre and is subject to pre-admission authorization.
2. The Third party Accident can be claimed upon getting the related medical information from the insured person /network provider.
3. Insurance company verifies that the person is eligible to claim under the policy or not.
4. If the verification satisfies it will issue a pre-authorization letter or guarantee of payment letter to the Hospital / Nursing Home / Day Care Centre.
5. The sum guaranteed as payable will be mentioned in that letter.
6. The reason for sickness for which the person is seeking to be admitted as a patient.
7. The Third party accident reserves the right to deny pre-authorization in case the insured person is unable to provide the relevant medical details as required by the Third Party Administrator.
8. The TPA will make it clear to the insured person that denial of Cashless facility is in no way construed to be denial of treatment.
9. The insured person may obtain the treatment as per his /her treating doctors advice and later on, submit the full claim papers to the TPA for reimbursement subject to admissibility of claim under terms and conditions of the policy.

Documents required for Oriental Insurance Claim Process

• Copy of Oriental Insurance Claim form is to be given to Company together with xerox of policy & premium receipt.
• Duly filled Claim Form.
• Hospital Discharge Report/Medical Treatment Report.
• Medical recovery report.
• Original Test Reports(X-Rays/Sonography/ECG etc.)
• Details of medical expenses original bills/cash memos receipts along with prescriptions.
• Leave certificate from employer.
• Hospital/Nursing Home Registration No. If not registered then, treating doctor’s certificate about no. of beds, availability of qualified doctors, qualified nurses/staff round the clock and fully equipped operation theatre in the hospital/Nursing home.
• Police Panchnama/first information report about accident.

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