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Personal Accident Claim
Personal Accident Claim
Personal Accident Claim

As part of our continuous efforts to enhance digitalisation, we are pleased to inform that claims submission of all classes can be done online. Please note that from 1 December 2021, ERGO no longer accept hardcopy claim forms.

To ensure speedy claims processing, please follow the below guidelines:

  1. All Claims Notification must be sent to ERGO Insurance Pte. Ltd. in Singapore within 30 days after the occurrence of any event which may give rise to a claim. Notification could be verbal or written, followed by the completed claim form;
  2. For general claims enquiries, please call 6829 9199 from 08.30am to 05.30pm, Monday to Friday except public holidays.
  3. To enable the Claims Department to process the claim at its best, the following information should be provided at the time of notification:
    (a) Policy Number
    (b) Circumstances of the accident/loss
    (c) Date/Place of accident/loss
    (d) Extent of loss
    (e) The type of coverage provided

For Emergency Medical Assistance, please call our ERGO Assistance Hotline at 6238 9909. (Please note that general claims enquiries will not be serviced at this number.)

  1. Certified true copy of death certificate
  2. Medical report form completed by treating doctor
  3. Detailed post mortem report/ autopsy report, or medical report if post mortem report/ autopsy report is not available
  4. Police report and findings on the alleged accident (if applicable)
  5. Copy of driver’s licence and certificate of auto insurance (if deceased was driving at the time of accident)
  6. Incident report lodged by the employer (if the accident is industrial or work related)
  7. Nominee’s identity card (if the insured has made a nomination under the policy) or copy of claimant’s identity card and proof of relationship (if the insured has not made any nomination under the policy)
  8. Letter of Administration or Probate (this is only applicable if the insured has not made a nomination under the policy)

  1. Police report and findings on the alleged accident (if applicable)
  2. Attending physician’s statement completed by the treating doctor
  3. All available medical reports or any other document to substantiate the claim
  4. Medical Specialist Report confirming the Permanent Disablement Accident report lodged by your employer (if the accident is industrial or work related)

  1. Original final medical invoices and receipts (as proof of payment)
  2. Police report for road traffic accidents or other accidents (if applicable)
  3. Accident report lodged by your employer (if the accident is industrial or work related)
  4. Certified true copy of medical report or Attending Physician’s Statement by treating doctor (medical report fees are borne by you as the claimant)

  1. Police report for road traffic accidents or other accidents (if applicable)
  2. Accident report lodged by your employer (if the accident is industrial or work related)
  3. Certified true copy of medical report or Attending Physician’s Statement by treating doctor (medical report fees are borne by you as the claimant)
  4. Copy of hospitalisation bills

  1. Certified true copy of medical report or Attending Physician’s Statement by treating doctor, indicating the type and location of fractures (medical report fees are borne by you as the claimant)
  2. Police report for road traffic accident or other accidents (if applicable)
  3. Accident report lodged by your employer (if the accident is industrial or work related)

  1. Please note that in accordance with the Policy terms, we will only pay for covered expenses if the services of ERGO Assistance or an authorised representative of ERGO Assistance is used to make the necessary arrangements for the return of the Insured’s mortal remains. Please call our ERGO Assistance Hotline at 6238 9909 for assistance.

Personal Accident Claim Form

Simply submit your claims via our online claim portal by following simple steps indicated below.

*Note: Each claim is unique and will be assessed based on its merit. We would, from time to time, request further information from you, for us to assess your claim. You do not need to send us original documents, however we require you to keep all original documents for 12 months from the date of submission, in the event we need to sight them. We would like to remind you, that we will deny claims that are either dishonest or of fraudulent nature, and such claims will be referred to the appropriate authorities.

Personal Information
The policy number must be entered The policy number format is invalid
The policy holder's name must be entered The policy holder's name can only contain letters
The claimant's name must be entered The claimant's name must only contain letters
The claimant's NRIC number must be entered The claimant's NRIC number must contain letters and numbers only
Your mobile number must be entered The entered mobile number format is invalid
Your email address must be entered Your email address must be entered
Your postal address must be entered
Claims Payment
The name of your bank must be entered
The SWIFT code for your bank must be entered The bank SWIFT code must contain between 8 and 11 letters and numbers only
Your bank account number must be entered
The bank account holder's name must be entered

Please provide your bank details for faster claims processing. Once approved, your claim amount will be credited into your bank account.

We will only credit into the Policyholder’s/Insured Person’s account. Notification of payment will be sent to your email address stated in your details.

The company shall:
  1. be discharged from all liability under this claim and
  2. not be liable for any and all losses incurred by you, as a result of you providing the company with inaccurate bank account number under this section for the payment of this claim.
Description of Claim
The amount being claimed must be entered
The location of the accident must be entered
The date of the accident must be entered
The nature of the claim must be entered
A brief description of the accident must be entered
Have you made a claim against any other party in respect of this event?
If yes, please provide details
The name of the third party/insurer must be entered
The third party policy/reference number must be entered
The type of third party benefits must be entered
You must answer if a claim has already been filed against the third party
You must enter the third party claim amount
I Agree

Upload Supporting Documents

If your medical claim value is above SGD$200, Please mail your original documents to Claims Department. For all other claims types, you do not need to send us original documents. However, we require you to keep all original documents for 6 months from the date of submission, in the event we need them.

1) Hospitalisation & Surgery Form – Page 1 consisting of Section A to C to be signed Claimant and Insured. Page 2 , Section D must be completed and endorsed by Claimant’s attending Physician/Surgeon. Please download, complete form and upload here * (JPG, PNG, GIF, PDF, ZIP)
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2) Medical report or inpatient discharge summary * (JPG, PNG, GIF, PDF, ZIP)
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3) Original medical bills and certificates * (JPG, PNG, GIF, PDF, ZIP)
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4) Any other supporting documents (JPG, PNG, GIF, PDF, ZIP)
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Declaration and Submission

By submitting this claim form online, you:

  1. declare that the particulars stated above are true, accurate and complete and understand that if you have in this or in any further declaration in respect of this claim, made any false or fraudulent statement or suppress conceal or falsely state any material fact whatsoever my claim may be refused and referred to the relevant /appropriate authorities .
  2. authorise any person or organisation who has relevant information on this claim, including any medical practitioner, health care provider, insurance company and investigative agencies, to release and exchange such information (including personal health information) requested by ERGO Insurance and/or its claims service providers.
  3. authorise ERGO Insurance and its claims service providers to collect, use, disclose and/or process your personal data set out in this form and any other information provided by you or possessed by ERGO Insurance for the purpose of enabling ERGO to provide you with services required of an insurance provider, such as evaluating, processing, administering, and/or managing of your relationship and policies with ERGO Insurance. This includes among other things policy servicing, processing, investigating, handling, administering and/or settling your claim with ERGO or other insurers.
  4. understand that ERGO Insurance may/will disclose and transfer your personal data to third parties, including but not limited to its affiliates, representatives, agents and third party service providers, lawyers/law firms, whether located within or outside Singapore, for one or more of the above purposes, and the said third parties may/will subsequently collect, use, disclose and/or process your personal data for or more of the above purposes;
  5. accept that the personal data protection clauses herein are not exhaustive and you have read, understood and accept the terms of ERGO’s Personal Data Protection Policy at https://www.ergo.com.sg/pdpa/;
  6. confirm that you are authorised to disclose information (including personal health information) about the insured person if this claim is made on behalf of them./li>
  7. confirm that you or the insured person is not claiming from any other insurance policy or on your or insured person's employment benefits provided by your or insured person’s employer.
  8. agree and accept that ERGO Insurance reserves the rights to contact the institution directly for validation of any submitted medical document’s authenticity and can request for the original bill/certified true copies whenever necessary within 1 year from the date of receipt of such medical document.

Please note that this procedure is only intended as a guide. Each claim submitted to ERGO will be reviewed based on its own merits in accordance with the concerned policy terms and conditions. We reserve our right to request for additional documents and/or information on a case-by-case basis.

Please keep all original documents and invoices for 12 months from the date of online submission for verification purpose

Kindly note that it may take longer to process a claim if we require additional information or documents from you. For any claims enquiry, amendment of details or submission of supporting or original documents, please email our friendly claims officers at onlineclaims@ergo.com.sg with your policy number

I Agree You must accept the terms of the above declaration

Important Note: The acceptance of this online claim form does NOT constitute an admission of liability by ERGO Insurance Pte Ltd. or waiver of its rights.