Maharashtra Health Department issues Form II regarding personal accident insurance claim form (Particulars of Accident)

Apr 29, 2020 | by Avantis RegTech Legal Research Team

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EHS Compliance

The Maharashtra Health Department on April 04, 2020, issues Form II regarding Personal Accident Insurance Claim Form for accidental loss of life on account of COVID-19 related duty.

This Form is in continuation of Form I which is related to personal accident insurance claim for loss of life due to COVID-19. In Form II the claimant has to mention particulars of accident like date of accident, time and place of accident, has post-mortem been conducted, Name and relationship of the claimant with the deceased.

Documents to be submitted along with the claim form:

 Identity proof of Deceased (Certified copy) 

 Identity proof of the Claimant (Certified copy) (Must fulfil clause 3 of this Form which talks about claim certifying authority)

 Proof of relationship between the Deceased and the Claimant (Certified copy) 

 Laboratory Report certifying having tested Positive for COVID-19 (in Original or Certified copy)

 Death summary by the Hospital where death occurred (in case death occurred in hospital) (Certified copy). 

 Death Certificate (in Original) 

 Certificate by the Healthcare Institution/ organization/ office, to:

a) The employees (Regular/Adhoc/Contractual/ Daily Wagers/ retired Government Officials/ Private individuals) who may have to be in direct contact and care of COVID 19 patients

b) Private healthcare Institution

c) Private person engaged by the Health Care Institutions / Organisations (both public and private) through an Agency

d) Community Health Workers (ASHAs and ASHA Facilitators)

e) Volunteer drafted for COVID 19 related responsibilities by the Government officials authorized by the Central/State/UT Government


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