(A) Death Claim
Important Notes:
- Pacific Life must be notified in writing within thirty (30) days from the date of the Death.
Checklist:
| 1 | Death Claim Form ([D3]) Part I
(Completed by the Claimant) |
| 2 | Death Claim Form ([D3]) Part II – Attending Physician Report
(Completed by the Deceased’s Last Attending Doctor) |
| 3 | Authorization Form |
| 4 | Original Death Certificate |
| 5 | Original Deceased’s Identity Card |
| 6 | Original Claimant’s Identity Card |
| 7 | Proof of relationship with the Deceased |
| 8 | Original Policy Document |
| 9 | Additional information may be required if necessary |
(B) Dread Disease Claim
Important Notes:
- Pacific Life must be notified in writing within thirty (30) days from the date of first diagnosis of Dread Diseases.
Checklist:
| 1 | Dread Disease Claim Form ([D4]) Part I
(Completed by the Claimant) |
| 2 | Dread Disease Claim Form ([D4]) Part II – Attending Physician Statement
(Completed by the Attending Physician) |
| 3 | Medical and Laboratory Test Report |
| 4 | Pathological Report |
| 5 | Consultation Summary |
| 6 | Discharge Summary |
| 7 | Sick Leave Certificate |
| 8 | Additional information may be required if necessary |
(C) Hospitalization Claim
Important Notes
- Pacific Life must be notified in writing within 30 days from the date of admission to Hospital in the event of any claim.
Checklist:
| 1 | Hospitalization Claim Form ([H1]) Part I
(Completed by the Claimant) |
| 2 | Hospitalization Claim Form ([H1]) Part II – Attending Physician Statement
(Completed by the Attending Physician) |
| 3 | Medical and Laboratory Test Report |
| 4 | Consultation Summary |
| 5 | Discharge Summary |
| 6 | Sick Leave Certificate |
| 7 | Original Receipt(s) issued by the Attending Doctor and/or Hospital / Clinic
(*Copies of Receipt(s) are accepted for Hospital Cash Claims only) |
| 8 | Additional information may be required if necessary |
Website: http://www.pacificlife.com.hk/