How to Make a Claim

To file a claim, an application form must be fully and accurately completed by the policyholder or beneficiary. Each claim must be submitted with the original claim form and its requirements.

Steps for Claim Procedure

Chubb Life provides each policy with a claim form. However, you still can obtain a new one via any of the following ways:

1. Through Chubb Life Care Hotline 14087
   Monday–Friday, 08.00 AM to 05.00 PM
2. Visit Chubb Life Marketing Offices
3. Send a Request Email to ChubbCare.ID@chubb.com
4. Download the e-form of Formulir Pengajuan Klaim
5. Contact your respective agent.

Document Requirements for Claim Submission

To submit a claim, the Policy Holder or Beneficiary must provide the following original documents (or legalized copies):

1. Health Insurance Claim Submission:
   • Health Insurance Claim Submission Form (completed by the Policy Holder).
   • Doctor’s Statement Form – Health Claim (completed by the attending physician).
2. Death Claim Submission:
   • Life Insurance Claim Submission Form (completed by the Policy Holder or Beneficiary).
   • Doctor’s Statement Form – Death Claim (completed by the attending physician).
3. Total and Permanent Disability Claim Submission:
   • Life Insurance Claim Submission Form (completed by the Policy Holder).
   • Doctor’s Statement Form – Total and Permanent Disability Claim (completed by the attending physician).
4. Critical Illness Claim Submission:
   • Life Insurance Claim Submission Form (completed by the Policy Holder).
   • Doctor’s Statement Form – Critical Illness Claim (completed by the attending physician).
   • For the following critical conditions, please provide a Doctor’s Statement specific to the condition experienced:
     • Stroke
     • Heart & Blood Vessel Disorders
     • Kidney Failure
     • Paralysis
5. Proof of identity for Policy Holder, Life Insured, and Beneficiary/Heir (National ID Card/Passport/KITAS, Family Card).
6. Medical Resume signed by the attending physician and stamped by the healthcare facility.
7. Supporting examination results (laboratory, radiology, anatomical pathology, etc.).
8. Receipts and detailed breakdown of treatment costs.
9. Accident Report from the Police and Driver’s License corresponding to the vehicle driven (if a traffic accident occurred).
10. Letter of Statement from the Indonesian Embassy (KBRI) or Indonesian Consulate General (KJRI) (if the accident occurred abroad).

Click here to find out about PT Chubb Life Insurance Indonesia’s Hospital Provider List: