Insurance Claim Form

Insurance Claim Form Template for Philippines

Create a bespoke document in minutes, or upload and review your own.

4.6 / 5

4.8 / 5

Let's create your Insurance Claim Form

1. Select your governing law and document type:

2. Enter your key requirements:

3. Create your document to edit, review or download

Get your first 2 documents free

Your data doesn't train Genie's AI

You keep IP ownership of your information

Key Requirements PROMPT example:

"I need an Insurance Claim Form for our manufacturing company's property damage claim resulting from the earthquake on March 15, 2025, ensuring compliance with Philippine Insurance Commission regulations and including provisions for business interruption coverage."

Document background

The Insurance Claim Form is a crucial document in the Philippine insurance industry, designed to facilitate the formal process of claiming insurance benefits under various types of insurance policies. This document is used when a policyholder needs to make a claim following an insured event, such as property damage, medical emergency, accident, or death. The form must comply with the Insurance Code of the Philippines and various regulations set by the Insurance Commission, including data privacy requirements under RA 10173. It captures essential information about the policyholder, the nature of the claim, circumstances of the loss or incident, and required supporting documentation. The document serves both as a formal notice of claim to the insurance company and as a legal declaration by the claimant, forming the basis for the insurance company's investigation and processing of the claim.

Suggested Sections

1. Policyholder Information: Basic details of the policyholder including full name, policy number, contact information, and address

2. Insurance Policy Details: Specific information about the insurance policy including type of coverage, policy period, and sum insured

3. Claim Information: Details of the incident or circumstance leading to the claim, including date, time, location, and nature of loss

4. Description of Loss/Damage: Detailed explanation of what happened and the extent of loss or damage incurred

5. Financial Information: Details of the claim amount, breakdown of costs, and any previous claims history

6. Third Party Information: Details of any third parties involved in the incident, including witnesses or other affected parties

7. Declaration and Authorization: Claimant's declaration of truth and authorization for the insurance company to investigate the claim

Optional Sections

1. Medical Information: Required for health or accident-related claims, including details of injury/illness, treatment received, and healthcare providers

2. Property Damage Details: Required for property insurance claims, including detailed description of damaged items and their value

3. Vehicle Information: Required for motor vehicle insurance claims, including vehicle details and accident specifics

4. Business Interruption Details: Required for commercial insurance claims involving business disruption

5. Death Claim Information: Required for life insurance death claims, including death certificate details and beneficiary information

6. Police Report Reference: Required when the claim involves a crime or requires police intervention

Suggested Schedules

1. Schedule A - Required Documents Checklist: Comprehensive list of documents required to support the claim based on claim type

2. Schedule B - Medical Report Form: Standard form for medical practitioners to complete for health-related claims

3. Schedule C - Property/Item Valuation Form: Detailed listing and valuation of damaged/lost items for property claims

4. Appendix 1 - Photo Documentation Guidelines: Instructions for submitting photographic evidence of damage/loss

5. Appendix 2 - Official Receipts Form: Template for organizing and submitting receipts and proof of expenses

6. Appendix 3 - Third Party Statement Form: Template for collecting statements from witnesses or involved parties

Authors

Alex Denne

Head of Growth (Open Source Law) @ ��Ƶ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

Relevant legal definitions

Clauses

Relevant Industries

Insurance

Healthcare

Real Estate

Automotive

Manufacturing

Retail

Construction

Transportation

Agriculture

Professional Services

Hospitality

Maritime

Relevant Teams

Claims Processing

Legal

Compliance

Customer Service

Risk Management

Underwriting

Documentation

Fraud Detection

Policy Administration

Client Relations

Relevant Roles

Claims Manager

Insurance Adjuster

Risk Manager

Compliance Officer

Insurance Agent

Claims Processing Specialist

Legal Counsel

Insurance Underwriter

Customer Service Representative

Claims Investigator

Policy Administrator

Risk Assessment Officer

Insurance Broker

Documentation Specialist

Fraud Detection Analyst

Find the exact document you need

Property Damage Liability Waiver

A Philippine law-compliant document that releases liability for property damage, suitable for various business and real estate transactions.

��������Ƶ

How ��������Ƶ reduced drafting time by 75% for a legal firm

Let's create your Insurance Claim Form

Authors

Alex Denne

Find the exact document you need

Property Damage Liability Waiver

Loss Of Coverage Letter

Certificate Of Workers Compensation (Insurance)

Insurance Claim Form

Insurance Waiver Form

Insurance Waiver

Dental Insurance Verification Form

Accident Claim Form

Medical Claim Form

Insurance Reimbursement Form

Insurance Verification Form

Qualified Health Coverage Letter

Car Insurance Form

Dental Claim Form

Subrogation Letter

Subrogation Form

Medical Charges Reimbursement Form

Claim Denial Letter

Life Insurance Cancellation Letter

Dental Insurance Breakdown Form

Travel Insurance Form

Accident Waiver

Workers Compensation Waiver Form

Driver Exclusion Form

Workers Compensation Waiver

Waiver Of Subrogation Form

Auto Insurance Cancellation Letter

Group Insurance Form

Transfer Of Insurance Form

Insurance Proposal Form

Event Liability Waiver

Insurance Declaration Form

Download our whitepaper on the future of AI in Legal

�ұ�Ծ���’s Security Promise

Your documents are private:

Your documents are protected:

Organizational security

Innovation in privacy:

Want to know more?

Use Cases

��Ƶ

How ��Ƶ reduced drafting time by 75% for a legal firm

�ұ�Ծ��’s Security Promise