0Hospital injury compensation in health insurance Definition
Hospital injury compensation in health insurance is a process of defining whether an insurance accident belongs to the insurance liability agreed in the insurance contract and calculating the compensation amount in accordance with the insurance contract.
health insurance involves human injury insurance reviews, which are nothing more than verification of the authenticity of the pre-, mid- and late-stage processes. In the verification of health insurance personal injury claims, the first step is to review the claims materials. So which materials should be reviewed?
Accidental medical insurance claims materials
Hospital settlement fee
One of the claims application materials submitted by the customer
- Account application materials submitted by the customer
If the insured is hospitalized, paid medical expenses or undergoes surgery due to accidental injury, the insured shall be the applicant or the third party or institution to fill out the "Account Application" (the claims certificate materials of each insurance company are slightly different but the similarity is nearly 90%), and submit the following proof materials:
- Claim Application
- Copy of the applicant and the copy of the bank card
- Insurance contract original and approval form.
- Hospital medical records, examination and other information issued by the insured person, emergency medical records, medical diagnosis, hospitalization medical records, examination reports and discharge summary issued by medical institutions ( is generally second-level or above ).
- Medical Notes Original receipts for medical expenses, expense details and medical insurance settlement statement issued by medical institutions.
- The requirements for proof of accidental accident are the same as those for accidental death.
- Other supporting documents that need to be provided may be required to provide relevant other supporting documents according to the specific circumstances of the accidental injury accident in .
- Evidence information obtained by the insurance company's investigation
Claim-related evidence collected by the insurance company during the investigation, such as inquiry records, photos of the injured part of the insured, etc.
- claims case
Zhangjiajie naturally formed "heart-shaped lake"
On September 19, 2018, Mr. Li went to Zhangjiajie for a trip and participated in a self-paid entertainment project at a playground in Zhangjiajie on the 21st. He accidentally fell while sliding down the hillside, causing a fracture of his right ankle joint. Mr. Li was discharged from the hospital for 19 days after being hospitalized in the hospital. After being discharged from the hospital, Mr. Li remembered that he had insured the comprehensive accident injury insurance of an insurance company, which contained accident medical insurance liability, so he called the insurance company to consult the information needed to make a claim. If you are a claim filer of an insurance company, please tell Mr. Li what claim information he needs to submit when applying for a claim.
Accidental Disability income loss insurance Claim materials
Sports injury
- Account application materials submitted by the customer
If the insurance claim for loss of work ability due to accidental injury, the insured person himself, as the applicant or the entrusts a third party, fill out the "Account Application Form" and submit the following supporting materials:
- Account Application Form
The filling standards for the application are the same as other claims applications. If the applicant becomes a person with no civil capacity or limited civil capacity, his legal guardian shall fill in and sign it. applicants should truthfully fill out the "Account Application" and the insurance company can use the "Account Application" to roughly understand the situation of the accidental injury accident and the degree of disability of the claimant.
- The valid ID and copy of the bank card of the applicant
- original insurance contract and approval form and other contract documents
- proof of disability
The qualification of labor capacity appraisal agency or judicial appraisal agency , and issue a certificate of disability or disability appraisal.
- Hospital medical records, examinations and other information
If the insured is sent to the hospital for treatment after accident, you must provide rescue medical records, outpatient medical records, inpatient medical records, diagnosis and treatment records, examination reports, etc.
- Accidental accident proof
The requirements for the accident proof are the same as those for the accidental death.
- Other proof documents that need to be provided
According to the specific circumstances of the accidental injury accident, the applicant may be required to provide other relevant proof documents.
- Evidence information obtained by the insurance company's investigation
During the investigation, the insurance company will actively collect evidence related to the claim, such as inquiry records, on-site inspection records, on-site photos, etc.
Accidental long-term care insurance claims information
Accidental injury leads to the loss of daily life ability and requires long-term care
- Account application information submitted by customers
If a long-term care insurance claim is claimed due to accidental injury and long-term care, the insured person himself, as the applicant, fill out the "Account Application" and submit the following proof information
- Claim Application
- Copy of the applicant's valid ID and bank card
- Original insurance contract and approval form and other contract documents
- Disability certificate or nursing certificate
- Specialist doctors at the medical institution level 2 or above will issue a diagnosis certificate or a qualified judicial appraisal institution.
- Hospital medical records, examinations and other information
If the insured is sent to the hospital for treatment after accident, you must provide rescue medical records, outpatient medical records, inpatient medical records, diagnosis and treatment records, examination reports, etc.
- Accidental accident proof
The requirements for the accident proof are the same as those for the accidental death.
- Other proof documents that need to be provided
According to the specific circumstances of the accidental injury accident, the applicant may be required to provide other relevant proof documents.
- Evidence materials obtained by insurance companies in the investigation
During the investigation, insurance companies will actively collect supporting materials related to claims, such as interrogation records, on-site inspection records, on-site photos and other auxiliary supporting materials.
Nursing
Original statement: This picture and text are original from Kuaiqi.com and Kuaiqi.com Claims Academy. Welcome to reprint
- Accidental accident proof
The requirements for the accident proof are the same as those for the accidental death.
- Other proof documents that need to be provided
According to the specific circumstances of the accidental injury accident, the applicant may be required to provide other relevant proof documents.
- Evidence information obtained by the insurance company's investigation
During the investigation, the insurance company will actively collect evidence related to the claim, such as inquiry records, on-site inspection records, on-site photos, etc.
Accidental long-term care insurance claims information
Accidental injury leads to the loss of daily life ability and requires long-term care
- Account application information submitted by customers
If a long-term care insurance claim is claimed due to accidental injury and long-term care, the insured person himself, as the applicant, fill out the "Account Application" and submit the following proof information
- Claim Application
- Copy of the applicant's valid ID and bank card
- Original insurance contract and approval form and other contract documents
- Disability certificate or nursing certificate
- Specialist doctors at the medical institution level 2 or above will issue a diagnosis certificate or a qualified judicial appraisal institution.
- Hospital medical records, examinations and other information
If the insured is sent to the hospital for treatment after accident, you must provide rescue medical records, outpatient medical records, inpatient medical records, diagnosis and treatment records, examination reports, etc.
- Accidental accident proof
The requirements for the accident proof are the same as those for the accidental death.
- Other proof documents that need to be provided
According to the specific circumstances of the accidental injury accident, the applicant may be required to provide other relevant proof documents.
- Evidence materials obtained by insurance companies in the investigation
During the investigation, insurance companies will actively collect supporting materials related to claims, such as interrogation records, on-site inspection records, on-site photos and other auxiliary supporting materials.
Nursing
Original statement: This picture and text are original from Kuaiqi.com and Kuaiqi.com Claims Academy. Welcome to reprint
