What are the procedures for making a group accident insurance claim for construction workers?

Application form ID card of the insured (beneficiary) Entrusting someone else to do it also requires a power of attorney, identity certificate of the entrusted person, salary statement or attendance sheet for the three months before the accident and the labor contract of the insured unit.

If you are dead or disabled, you may also need a safety supervision certificate, a death certificate, a certificate of household registration, a funeral certificate, a construction contract, a construction project cost, etc.

You need to prepare the following materials:

The insurance policy and the list of the insured, a copy of the injured person's ID card, a hospital diagnosis certificate, a test report, a receipt of medical expenses and a list (outpatient prescription), etc., go to the insurance company to make a claim, and the insured (the injured) fills in the claim application.

Group accident insurance, the full name of group accident insurance, is a personal accident insurance purchased in a group way, and its insurance liability and payment method are the same as personal accident insurance.

The insurance policy and the list of the insured, a copy of the injured person's ID card, a hospital diagnosis certificate, a test report, a receipt and list of medical expenses.

When settling claims, most of the group insurance follows the level 7 disability compensation standard issued by the Chinese People's Bank of China, that is, the level 8 and level 9 disability within the scope of work-related injury appraisal are not within the scope of compensation.

In the process of building construction, grade 8 and grade 9 disability accidents still often occur, which means that the group insurance coverage is not comprehensive enough. There is a limit on the number of people who increase or decrease the number of personnel, and the change of general personnel cannot exceed 30% of the total number of people.

If it is a general enterprise or institution, it is generally more suitable, and for those units with strong personnel mobility, such as engineering companies, security companies, etc., it is not very suitable.

Prepare the following procedures: insurance policy and list of insureds, copy of the injured person's ID card, hospital diagnosis certificate, test report, medical fee receipts and list (outpatient prescription), etc., to the insurance company to claim, while the insured (injured) fill in the claim application, if you may be disabled, you need to do a disability identification, and then claim after the disability, the insurance company will be slightly different, you can call customer service ** to consult.

Report to the insurance company, the insurance company should verify the accident, and the information that needs to be submitted includes medical records, invoices, applications, ID cards, explanations of the accident, and if you apply for disability, you must wait until the end of the medical treatment period to do the appraisal, and whether to submit the safety supervision certificate depends on whether there is an agreement at the time of insurance.

Materials Generally, it is also necessary to issue a relevant accident certificate issued by the competent department of construction safety (such as the safety supervision station) If it is an anonymous insurance insured according to the construction project, it is also necessary to provide pay slips, attendance sheets and other materials to prove that the worker is a person from the construction site.

Call the insurance company ** to report the case, and if you buy the insurance with the salesman, find the salesman to help you deal with it.

Accidental injury claims basically pay for accidental death, disability, accidental injury hospitalization medical subsidies and medical expenses! If you buy it, you can see the terms of the contract that can be reimbursed, and then you can roughly know how much you can reimburse for the disability certificate of the corresponding hospital! 、

Claims are divided into outpatient and inpatient:

1) Accident outpatient clinic: the insured's valid identity document, diagnosis certificate, outpatient handbook or emergency medical record, outpatient medical fee receipts and details, and the insured's attendance certificate and salary certificate in the past three months are also required.

2) Accidental hospitalization: The insured's valid identity document, discharge summary, medical records, original receipts and details of hospitalization medical expenses, as well as attendance certificates and salary certificates of the insured in the past three months are also required.

It is divided into accidental outpatient and accidental hospitalization.

Accident Outpatient Clinic: Valid ID card, medical certificate, outpatient handbook or emergency medical record, receipts and details of outpatient medical expenses, attendance certificate and salary certificate of the insured in the past three months are required.

Accidental hospitalization: The insured's valid identity document, discharge summary, medical records, original receipts and details of hospitalization medical expenses are required, and the insured's attendance certificate and salary certificate for the past three months are also required.

Extended information: The outpatient clinic usually receives patients with mild symptoms, and after a set of diagnostic methods and auxiliary examinations by the outpatient doctor, the patient is given a preliminary diagnosis, and the outpatient doctor can give the patient **, that is, the patient's symptoms, if the outpatient doctor has doubts about the patient's condition or is diagnosed as a serious and urgent condition, the patient will be admitted to the inpatient ward, and the patient will be admitted to the hospital for further examination or surgery or related medical measures.

Some accident insurance covers accident clinics, but it does not mean that accident insurance is accident clinics.

Nowadays, most accident insurance covers accidental outpatient, accidental medical, accidental disability and accidental death.

Therefore, it is best to read the terms and conditions of the insurance when buying accident insurance.

Generally speaking, it is a combination of outpatient and emergency departments, and many smaller hospitals are called outpatient and emergency, and large-scale hospitals are separated, with two departments: outpatient and emergency.

Accidental hospitalization medical insurance often takes the form of actual reimbursement, and the amount of compensation may only be less than the actual cost, and if you purchase accidental hospitalization medical insurance with hospitalization allowance insurance, then you can also provide additional financial compensation for the loss of lost work expenses caused by hospitalization medical treatment, and the higher part can be used for nutrition expenses, lost work expenses, transportation expenses, companionship expenses, nursing expenses, and enjoy higher level and higher quality medical services such as single room and expert diagnosis and treatment.

The insurance company shall pay the medical insurance premium for accidental hospitalization of the insured in accordance with the contract for the medical expenses incurred by the insured due to hospitalization caused by accidental injury.

The insurance company shall pay the medical insurance premium for accidental hospitalization of the insured in accordance with the contract for the medical expenses incurred by the insured due to hospitalization caused by accidental injury.

Inpatient Medical Benefit Benefits:

If the insured person is under the age of 18 at the time of admission or is hospitalized in the capacity of social health insurance or publicly funded medical treatment, he/she will receive:

Inpatient Medical Benefit = 95% of Medical Expenses Out-of-Pocket Amount*3

For an insured person who is at least 18 years old at the time of admission, if he or she is not under social health insurance and is not hospitalized as a publicly-funded medical institution, he or she will receive:

Inpatient Medical Reimbursement = 90% Medical Expenses Out-of-Pocket Portion, Medical Out-of-Pocket Portion = Inpatient Medical Expenses - Hospitalization Expenses Reimbursement Received. "

Compensation for accidental injuries within the insured period and within the insured area.

Now the pace of enterprise development is advancing rapidly, in the major emerging enterprises, grassroots operators are more and more, many bosses in order to transfer the risk on the choice of employees to buy group accident insurance, when buying group accident insurance, if once out of the insurance can also immediately apply for a claim, it should be noted that the claim is neededBring your own insurance policy and the list of insurers, a copy of the injured person's ID card, a diagnosis certificate from the hospital, a test report, and a receipt and list of medical expenses, and then go to the relevant department for compensation

It has to be said that in the process of building construction, level 8 and level 9 disability accidents still occur frequently, that is to say, the group accident insurance protection is not comprehensive enough, if there are conditions, they still buy a commercial insurance, so as to better protect our life safety, group accident insurance, relatively speaking, more suitable for enterprises and institutions. Hopefully everyone will notice this.

It has to be said that after the group accident insurance is out of the insurance, you should also learn to settle the claim, and before and after the group accident insurance, you should use an appropriate way to make it clear to the employee that if you find a fatal injury accident in real life. The amount of compensation for group accident insurance is limited, and if you want better protection, then you still have to add other types of insurance to hope that everyone can know about it.

At the same time, the insured suffered an accidental injury, from the date of the accident, within 180 days, can apply for accidental disability insurance, which also has a very good protective effect on our health, I have to say that before the insurance must be clearly designated beneficiary to do, if there is no designated beneficiary in the future claim process will let us be greatly hindered, I hope everyone can know about this, I have to say that after the accident, We should also coordinate with the insurance company in a timely manner.

When applying for a claim, you should fill in some **, and you should also make it clear to the insurance officer, so that you can carry out reasonable operations, and it is very good.

If there is an accident, then you can send the evidence of the accident, go to the hospital for the first bill, and send the diagnosis certificate given by the doctor to the insurance company, so that the insurance company will send someone down to verify, if there is no mistake in the suitability, then you can upload the information through the app to get compensation.

The first thing is to prepare some evidence of the previous purchase of insurance, and then to prepare some of the impact of the accident to determine the qualification, and then to the insurance company and the local ** to make a claim.

Legal Analysis: The compensation standard mainly includes three aspects: accidental death, accidental disability, and accidental medical treatment. The details are as follows:

1) Accidental Death and Disability Compensation: The amount of accidental death compensation is the maximum compensation limit for the insurance type; The compensation standard for accidental disability is divided according to the degree of disability, which is divided into levels 1 to 10, with the heaviest being the first level and the lightest being the 10th, and the insurance payment ratio corresponding to the first level of disability is 100%, and the insurance payment ratio corresponding to the tenth level of disability is 10%, with a difference of 10% for each level.

2) Accidental medical compensation: It is a compensation amount for losses, and the amount of compensation does not exceed the actual medical expenses spent. For example, if the insurance amount for accidental medical treatment is 10,000 yuan, but the insured** cost is 5,000 yuan, then the maximum compensation cost after review is 5,000 yuan.

Legal basis: Article 48 of the Construction Law of the People's Republic of China stipulates that construction enterprises shall pay work-related injury insurance premiums for employees to participate in work-related injury insurance in accordance with the law. Enterprises are encouraged to apply for accident insurance and pay insurance premiums for employees engaged in dangerous operations.

Insurance Law of the People's Republic of China Article 10 Paragraph 3 The insurer refers to the insurance company that has entered into an insurance contract with the policyholder and assumes the responsibility of compensation or payment of insurance money in accordance with the contract.

The material is large and contains wheels.

Generally required.

The competent department of building safety (such as the safety supervision station) shall issue a relevant accident certificate.

If it is an anonymous insurance insured according to the construction project, it is also necessary to provide pay slips, attendance sheets and other materials to prove that the worker is a veteran of the construction site.