Making a critical illness claim

Claimant Statement 

Download Claimant Statement - Critical Illness

One (1) valid government-issued photo ID of the claimant

Complete Medical Records supporting the critical illness diagnosis (duly certified by the issuing hospital/institution):

• Admission and Discharge Summary;

• Clinical Summary and Abstract;

• Diagnostic procedure results supporting the diagnosis (e.g. ECG, biopsy, blood test, ultrasound, MRI, any endoscopy procedure, x-ray, etc..)

• History Sheet: Contains the chief complaint, personal and family history (past and present)

For cancer

• Attending Physician’s Statement – Crisis Cover (Cancer, Terminal and Other Illnesses)

  Download Attending Physician’s Statement – Crisis Cover (Cancer, Terminal and Other Illnesses)

• Biopsy and/or histopathology results

• If leukemia, bone marrow diagnostic result

  
  
  

For stroke

• Attending Physician’s Statement – Crisis Cover (Stroke)

  Download Attending Physician’s Statement – Crisis Cover (Stroke)

• CT scan or MRI result/s

  
  
  

For heart attack

• Attending Physician’s Statement – Crisis Cover (Heart Attack) 

  Download Attending Physician’s Statement – Crisis Cover (Heart Attack) 

• All ECG Results and interpretations – Series

• Cardiac enzyme – Troponin / CK-MB

• Coronary angiogram result

• Echocardiogram, if any

  
  
  

For brain tumor

• Attending Physician’s Statement – Crisis Cover (Cancer, Terminal, or Other Illnesses)

  Download Attending Physician’s Statement – Crisis Cover (Cancer, Terminal, or Other Illnesses)

• All CT scan/s

• Biopsy result, if any

• MRI result/s

• Record of operation, if any

  
  
  

For renal failure

• Attending Physician’s Statement – Crisis Cover (Renal Failure) 

  Download Attending Physician’s Statement – Crisis Cover (Renal Failure)

• BUN

• Creatinine

• Dialysis record (Certified True Copy)

• Glomerular Filtration Rate (GFR)

• Urinary Creatinine Clearance

• Urinary Protein Determination