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Hospitalization & Critical Illness Claim

  • Claim Forms (Download this form in other Language)
    1. For Hospitalization:
      1. Part I: Claimant's Statement
      2. Part II: Physician's
    1. For Critical Illness:
      1. Part I: Claimant's Statement
      2. Part II: Physician's
  • Copies of Hospital Bills for the confinement & Copies of all related clinical Reports pertaining to the claim event
  • Attested True Copy of Indoor Case Papers of the hospital
  • Discharge summary of present and past hospitalizations
  • Photo Identity of Life Assured with age and address proof  (List of acceptable ID and Address proofs of claimant)
  • Bank Details of the claimant – Cancelled cheque (with printed name and account number) / bank passbook and NEFT Form
  • Medical Examination Certificate (First Consultation Notes)
  • All related clinical Reports pertaining to the claim event Know more
    1. Laboratory test reports
    2. X-Ray / CT Scan / MRI Reports & Plates
    3. Ultrasonography Report
    4. Histopathology Report
    5. Clinical / Hospital Reports
    6. Angiography Reports & Plates
    7. Certificate of Diagnosis
  • All follow-up Consultation Notes in relation to the hospitalized condition.
If hospitalisation is due to accidental causes (submit in addition to the above) Know more
Please Note:
  • Please submit copies of the following documents certified / attested by the issuing authority. ( Original Seen Verified (OSV) by Branch Personnel will also be accepted) -
    1. All Police papers – Panchnama, Inquest, First Information Report and Final Investigation Report
    2. Medical Records (Admission Notes, Discharge/Death Summary, Indoor Case Papers, Test Reports etc)
  • Copies of the other documents to be submitted by self attestation of the claimant
  • In case the claim warrants any additional requirement, TALIC reserves the right to call for the same.
  • Notification of claim & submission of the claim requirements does not mean admission of the claim liability by the Company.
  • No agent is authorized to admit any liabilities on behalf of the Company, nor to alter this list of documents or any claims requirements called for by the Company.