What to do in the event of a claim?

When submitting the notice of claim, the coverages described on the policy or certificate declarations page must be taken into account. The insured or beneficiary must prove the occurrence and amount of the claim, for which they may submit the following documents depending on the coverage being claimed:

I. For Basic Life coverage, Additional Accidental Death Indemnity, Funeral Allowance, Family Grocery Allowance for Death, Domestic Transfer Expense Allowance, Repatriation Allowance and Education Allowance.

• Notice of claim
• Civil death certificate stating the cause of death, issued by the competent authority in the country where the death occurred.
• Copy of the Insured's identity document
• Copy of the beneficiary's identity document; if the beneficiary is a minor, a birth certificate and a copy of the identity document of the surviving father or mother or of the appointed guardian must be provided.
• If no beneficiaries have been designated, the legal beneficiaries provided for in article 1142 of the Commercial Code will be considered.
• Certification of Continued Membership in the Insured Group form, issued by the Insurer and completed by the Policyholder (to prove continuity).
• In the case of death due to illness, the medical records must be provided. Documents issued abroad must be duly apostilled or legalized by the respective consulate.
• Certificate of outstanding debt balance (applies to group credit life policies)

• Any other document necessary to prove the occurrence and amount of the case.

   

II. Optional total and permanent disability coverage and Family Grocery Allowance for Total and Permanent Disability.

• Notice of claim.
• Copy of ID card.
• Certificate from the attending physician and copy of the medical records,  detailing the causes, dates and duration of the disability.
• Total and Permanent Disability Assessment issued by the Disability Rating Board or by the competent Entity in the case of special regimes.

III. Daily Hospitalization Income for Illness or Accident, Daily Income for Hospitalization in the Intensive Care Unit (ICU), Daily Post-Hospitalization Income, Daily Income for Home Hospitalization.

• Notice of claim.
• Copy of ID card.
• Certificate from the attending physician detailing the causes of hospitalization, dates of diagnosis and days of hospitalization, or a copy of the medical records showing the hospital admission and discharge dates.

IV. Critical Illness and Reinstatement of the sum insured for critical illness

• Notice of claim.
• Copy of ID card.
• Certificate from the attending physician detailing the causes, dates and diagnosis of the illness.

V. Accidental Dismemberment Benefits

• Notice of claim.
• Copy of ID card.
• Certificate from the attending physician detailing the dates and causes of the functional or anatomical loss of one of the limbs or organs, or traumatic or surgical amputation.
• Medical records or Certificate from the attending physician detailing the dates and causes of the functional or anatomical loss of one of the limbs or organs, or traumatic or surgical amputation.

VI. Outpatient Surgery Allowance

• Notice of claim.
• Copy of ID card.
• Certificate from the attending physician detailing the dates and causes of the outpatient surgery.
• Medical records or Certificate from the attending physician detailing the dates and causes of the outpatient surgery.

VII. Birth Allowance

• Notice of claim.
• Copy of ID card.
• DANE live birth certificate or civil birth registration

VIII. In the Event of Involuntary Unemployment

• Formal claim document signed by the insured
• Photocopy of the insured's identity document enlarged to 150%.
• Original or certified copy of the document evidencing the termination of the employment relationship, specifying the type of employment contract and the reason for its termination, or a dismissal letter detailing the aforementioned information.
• Original or certified copy of the document evidencing the final settlement of wages and employee benefits. For each month of Involuntary Unemployment and up to the maximum period covered, a sworn statement before a notary attesting that the situation continues.

IX. In the Event of Termination of the Contract by Mutual Agreement with a Bonus

• Formal claim document signed by the insured
• Photocopy of the insured's identity document enlarged to 150%.
• Settlement record (acta de conciliación) before the competent authority.
• Final settlement of employee benefits, showing that the employer granted a discretionary bonus.
• Employment Contract.
• For each month of Involuntary Unemployment and up to the maximum period covered, a sworn statement before a notary attesting that the situation continues.

X. In the Event of Total Temporary Disability

• Formal claim signed by the insured.
• Photocopy of the insured's identity document enlarged to 150%.
• Certificates, original medical tests and a copy of the medical records proving total temporary disability for more than 30 calendar days, issued by a physician affiliated with the EPS, ARL or a specialist in occupational medicine.
• If you are making contributions to the social security system as a contributor, attach a copy of the statement of those contributions.

XI. Extension of Total Temporary Disability

• In the event of an extension of the state of Total Temporary Disability, you must submit medical certificates and tests proving the continuity of the total temporary disability, transcribed by the physician assigned to the EPS