{"id":1089,"title":"CLAIM FORM – ABILITY SHIELD INSURANCE POLICY","purpose":"claim","insurer":{"slug":"raheja-qbe-general-insurance","name":"Raheja QBE General Insurance Co. Ltd."},"source_pdf":"https://rahejaqbe.com/uploads/images/ability-shield-insurance/pdf/download/ability-shield-insurance-claim-form-V01.pdf","sha256":"3ed6a1743db018d736452dac0a8549b43d8c59d445a400299a61f9327efb2d72","pages":6,"collected":"2026-10-17","instructions":{"about":"This form is used by the policyholder or claimant to file a claim under the Ability Shield Insurance Policy. It collects details about the policy, claimant, illness or injury, and medical treatment.","notes":["Please answer all questions completely.","If space is insufficient, use a separate sheet and attach it.","Issuance of this form is not an admission of liability.","Attach original or photocopies of all required documents as listed.","Legal Heir Certificate is mandatory if nominee is not mentioned on policy schedule.","Authorization letter required if another party is handling the claim.","Medical Attendant’s Certificate must be signed and stamped by the treating doctor."],"title":"CLAIM FORM – ABILITY SHIELD INSURANCE POLICY","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Policy Holder’s Details","fields":[{"help":"","type":"text","label":"Policy No:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Claim No:","options":[],"required":null,"pdf_field":""},{"help":"Enter start and end dates of policy period","type":"date","label":"Policy Period: From To","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Corporate Name:","options":[],"required":null,"pdf_field":""},{"help":"Full postal address","type":"text","label":"Address:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State:","options":[],"required":null,"pdf_field":""},{"help":"Postal code","type":"number","label":"Pin code:","options":[],"required":null,"pdf_field":""},{"help":"Mobile phone number","type":"phone","label":"Mobile Number:","options":[],"required":null,"pdf_field":""},{"help":"Email address","type":"email","label":"Email ID:","options":[],"required":null,"pdf_field":""},{"help":"Alternate phone number","type":"phone","label":"Phone No:","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder or claimant"},{"title":"Claimant’s Details","fields":[{"help":"Full name of claimant","type":"text","label":"Name:","options":[],"required":null,"pdf_field":""},{"help":"Email address","type":"email","label":"Email:","options":[],"required":null,"pdf_field":""},{"help":"Full postal address","type":"text","label":"Address:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State:","options":[],"required":null,"pdf_field":""},{"help":"Postal code","type":"number","label":"Pin code:","options":[],"required":null,"pdf_field":""},{"help":"Mobile phone number","type":"phone","label":"Mobile Number:","options":[],"required":null,"pdf_field":""},{"help":"Email address","type":"email","label":"Email ID:","options":[],"required":null,"pdf_field":""},{"help":"Alternate phone number","type":"phone","label":"Phone No:","options":[],"required":null,"pdf_field":""},{"help":"Relationship to the insured person","type":"text","label":"Relationship with Insured Person:","options":[],"required":null,"pdf_field":""},{"help":"Name of the insured member","type":"text","label":"Name of the Insured Person:","options":[],"required":null,"pdf_field":""},{"help":"Gender of insured person","type":"choice","label":"Sex:","options":["Male","Female","Other"],"required":null,"pdf_field":""},{"help":"Date of birth of insured person","type":"date","label":"Date of Birth:","options":[],"required":null,"pdf_field":""},{"help":"ID number of insured member","type":"text","label":"Employee/Member Identification No:","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Claims under Which Benefits","fields":[{"help":"Indicate if confined to bed","type":"yes-no","label":"Confinement to bed Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Specify type of confinement if yes","type":"choice","label":"If yes, Intermittent Bedridden","options":["Intermittent","Bedridden"],"required":null,"pdf_field":""},{"help":"Tick all activities the insured member cannot perform","type":"checkbox","label":"Activities of Daily Living which insured member is unable to perform Bathing Dressing Eating Toileting Transferring Continence Hygiene Feeding Independent movement Others","options":["Bathing","Dressing","Eating","Toileting","Transferring","Continence","Hygiene","Feeding","Independent movement","Others"],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Details of Disability cause due to Illness/Injury","fields":[{"help":"Date when illness or injury occurred","type":"date","label":"Date of Illness/Injury","options":[],"required":null,"pdf_field":""},{"help":"Time of illness/injury with AM/PM","type":"text","label":"Time","options":[],"required":null,"pdf_field":""},{"help":"Location where illness or injury occurred","type":"text","label":"Place of Illness/Injury","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Postal code","type":"number","label":"Pin code","options":[],"required":null,"pdf_field":""},{"help":"Describe cause of illness or injury","type":"text","label":"How did Illness/Injury occur?","options":[],"required":null,"pdf_field":""},{"help":"Indicate if injury was reported to police","type":"yes-no","label":"If Injury, was it reported to Police? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Police station details if reported","type":"text","label":"Name and address of Police Station","options":[],"required":null,"pdf_field":""},{"help":"FIR number if applicable","type":"text","label":"FIR No","options":[],"required":null,"pdf_field":""},{"help":"Date of FIR","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Details of MLC report if available","type":"text","label":"Medico Legal Certificate (MLC) Report","options":[],"required":null,"pdf_field":""},{"help":"Reason for not reporting to police","type":"text","label":"If no, please give reasons","options":[],"required":null,"pdf_field":""},{"help":"Indicate if witnesses exist","type":"yes-no","label":"Are there any witnesses to the accident? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Describe injuries or illness sustained","type":"text","label":"Details of Injuries/Illness Sustained","options":[],"required":null,"pdf_field":""},{"help":"Describe extent of disablement","type":"text","label":"Extent of disablement","options":[],"required":null,"pdf_field":""},{"help":"Provide details of medical practitioner consulted","type":"text","label":"Hospitalization/Treatment details: Name, Address, and contact details of Medical Practitioner consulted after the Injury/Illness","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Hospitalization Details","fields":[{"help":"Indicate if hospitalization occurred","type":"yes-no","label":"Was the Insured Person hospitalized following the Illness/Injury? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Hospital details if hospitalized","type":"text","label":"If yes, please provide the name, address & contact details of the hospital","options":[],"required":null,"pdf_field":""},{"help":"Hospitalization start and end dates","type":"date","label":"Period of hospitalization: From To","options":[],"required":null,"pdf_field":""},{"help":"Estimated claim amount","type":"amount","label":"Estimate of Claim Amount","options":[],"required":null,"pdf_field":""},{"help":"Provide details of other insurance policies if any","type":"table","label":"Details of any other insurance (arranged by self, spouse, parents or employee) under which claimant/deceased is covered: Name of insurer, Policy Number, Period of Insurance, Coverage, Sum insured","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Declaration by Insured/Claimant","fields":[{"help":"Date of signing","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Signature of Insured/Claimant","options":[],"required":true,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Employer Certification (Applicable for Employer-Employee Policy)","fields":[{"help":"Employee identification number","type":"text","label":"Employee ID No.","options":[],"required":null,"pdf_field":""},{"help":"Insurance policy number","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"Sum insured under policy","type":"amount","label":"Sum insured","options":[],"required":null,"pdf_field":""},{"help":"Authorized signatory's signature","type":"signature","label":"Signature of Authorized signatory","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Name and designation of signatory","type":"text","label":"Name & Designation of Authorized signatory","options":[],"required":null,"pdf_field":""},{"help":"Company seal or stamp","type":"attachment","label":"Company Seal","options":[],"required":null,"pdf_field":""}],"filled_by":"employer"},{"title":"Documents to be attached","fields":[{"help":"Attach all listed documents as applicable","type":"attachment","label":"Documents to be attached to the claim form","options":[],"required":true,"pdf_field":""}],"filled_by":""},{"title":"Medical Attendant’s Certificate","fields":[{"help":"Duration of medical relationship","type":"text","label":"How long have you known this patient?","options":[],"required":null,"pdf_field":""},{"help":"Indicate if usual doctor","type":"yes-no","label":"Are you his/her usual Medical Attendant? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Patient's full name","type":"text","label":"Name of Patient","options":[],"required":null,"pdf_field":""},{"help":"Patient's occupation","type":"text","label":"Occupation","options":[],"required":null,"pdf_field":""},{"help":"Explain injury cause","type":"text","label":"Are the injuries solely due to the accident or traceable to any previous injuries / Illness?","options":[],"required":null,"pdf_field":""},{"help":"Describe injuries or illness","type":"text","label":"Kindly state the nature of and extent of injuries/Illness","options":[],"required":null,"pdf_field":""},{"help":"Confirm consistency","type":"yes-no","label":"Is the injury consistent with claimant’s description of the accident? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Indicate connection to previous conditions","type":"yes-no","label":"Are the injuries connected with any previous injury/Illness, infirmity, or disease? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Details of previous conditions","type":"text","label":"If yes, please provide details","options":[],"required":null,"pdf_field":""},{"help":"Date of first consultation","type":"date","label":"When were you first consulted for this injury/Illness (DD/MM/YYYY)","options":[],"required":null,"pdf_field":""},{"help":"Other doctors consulted","type":"text","label":"Please give details of other consultations (if any): Doctor’s Name, Address, Contact No.","options":[],"required":null,"pdf_field":""},{"help":"Indicate ongoing treatment","type":"yes-no","label":"Are you still treating the patient for the injury/Illness? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Treatment details","type":"text","label":"Kindly provide details of treatment prescribed","options":[],"required":null,"pdf_field":""},{"help":"X-ray findings and report","type":"text","label":"If x-ray has been done, please mention the findings and Radiologist’s report","options":[],"required":null,"pdf_field":""},{"help":"Hospital name","type":"text","label":"If the patient was hospitalized, please give name of the hospital","options":[],"required":null,"pdf_field":""},{"help":"Surgery date and details","type":"date","label":"Date & Nature of surgical procedure, if any (DD/MM/YYYY)","options":[],"required":null,"pdf_field":""},{"help":"Indicate complications","type":"yes-no","label":"Are there any complications which may retard the recovery? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Details of complications","type":"text","label":"If yes, please give details","options":[],"required":null,"pdf_field":""},{"help":"Indicate intoxication status","type":"yes-no","label":"Was the patient under the influence of intoxicants or drugs at the time of accident? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Period of total disability","type":"date","label":"While under your care and direction, how long was or will the patient be totally unable to perform activities of daily living from (DD/MM/YYYY)","options":[],"required":null,"pdf_field":""},{"help":"Additional comments on recovery","type":"text","label":"Please comment on any additional factor that may prolong recovery from injury/Illness/disability","options":[],"required":null,"pdf_field":""},{"help":"Doctor's signature","type":"signature","label":"Signature","options":[],"required":true,"pdf_field":""},{"help":"Doctor's name","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"Doctor's qualification","type":"text","label":"Qualification","options":[],"required":null,"pdf_field":""},{"help":"Doctor's address","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"Medical registration number","type":"text","label":"Registration No","options":[],"required":null,"pdf_field":""},{"help":"Date of certificate","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Doctor's official seal or stamp","type":"attachment","label":"Please affix official seal/stamp","options":[],"required":true,"pdf_field":""}],"filled_by":"treating doctor/medical attendant"}],"deadlines":[],"applies_to":"Claims under Ability Shield Insurance Policy - Group","attachments":["Duly completed Claim Form signed by Insured/ Nominee","Attending Physician’s Statement","Claimant’s Statement – brief details of accident/illness","Copies of medical documents supporting the disability and treatment","Copies of Investigation Reports and X-Ray films supporting the accidental injury","Photocopy of Policy Schedule /Certificate of Insurance / KYC documents / Employee ID","Leave Records with seal and signature of Authorized signatory (for Employer Employee Group Policy)","Employee ID card","First Information Report and Final Police report, wherever necessary","Bills and receipt towards expenses relevant to funeral ceremony / repatriation of mortal remains","Death certificate, wherever applicable","Copy of Photo ID and Address Proof of Insured Member","Legal Heir Certificate with affidavit and indemnity bond (if nominee not mentioned)","Authorization Letter if authorizing another party to handle claim","Consultation papers for all past and ongoing treatments","NEFT/Bank Details and cancelled cheque","KYC (Identity proof with Address – Pan card, Aadhar card, CKYC form)","Photocopy of 12 months’ Salary slips/ Form 16/26/ITR as per insurer discretion","Any other relevant documents requested during claim processing"],"declarations":["The information provided is true and no material information is concealed.","False declarations may result in refusal of claim payment.","Authorization is given to hospitals and medical providers to share medical details with the insurer.","Employer certifies the employee's leave and coverage details are true to the best of their knowledge.","Medical Attendant certifies the correctness of the medical information provided."],"dropped_labels":7},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"email","value":"customercare@rahejaqbe.com","label":"Claims service mail ID","level":null,"hours":"Monday to Saturday, 9 am to 8 pm","applies_to":"all","source_url":"https://rahejaqbe.com/claims","quote":"Commercial Lines Claims\nClick here\nto track you claim status\nClick here\nto Register a Claim\nIntermediaries\n18001027723\ncustomercare@rahejaqbe.com\nContact Us\nHospital\nLocator\nGarage\nLocator\nRegister\na Claim\nRegister\nComplaint With Us\nPolicy\nServicing\nLet us call you","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"info@mediassistindia.com","label":"Medi Assist TPA Email","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"TPA.\nContact number-\n1800-4259-449\n,\n9122-66620808\n,\n1800202022\n,\n1800220102\n,\n080-28004114/18004257878\nEmail address-\ninfo@mediassistindia.com\n,\ncontact.phs@paramounttpa.com\n,\nsupport@volohealthtpa.com\n,\ncustomersupport@healthindiatpa.com\n,\nhelp@vidalhealthtpa.c","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"cashless@mediassist.in","label":"Medi Assist TPA Cashless Email","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":", kindly visit\nhttps://www.medibuddy.in/claim\nToll Free Number :\n1800-4259-449\nEmail Address :\ninfo@mediassistindia.com\ncashless@mediassist.in\nCashless everywhere\nReimbursement claim registration :\nRetail\nCorp employee\nMedi Assist Insurance TPA Pvt. Ltd.\n4th Flo","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"contact.phs@paramounttpa.com","label":"Paramount TPA Email","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"4259-449\n,\n9122-66620808\n,\n1800202022\n,\n1800220102\n,\n080-28004114/18004257878\nEmail address-\ninfo@mediassistindia.com\n,\ncontact.phs@paramounttpa.com\n,\nsupport@volohealthtpa.com\n,\ncustomersupport@healthindiatpa.com\n,\nhelp@vidalhealthtpa.com\n,\nFor claim registration of","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"nonetwork.phs@paramounttpa.com","label":"Paramount TPA Non-network Email","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"ttpa.com/PolicyClaim/PolyClaimStatus.aspx\nToll Free Number :\n9122-66620808\nEmail Address :\ncontact.phs@paramounttpa.com\nnonetwork.phs@paramounttpa.com\nCashless everywhere\nReimbursement claim registration\nClaim tracker/status for all type of claims.\nParamount TPA Office","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"assistance@volohealthtpa.com","label":"Volo Health TPA Email","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"ed (Annual Disclosure) – Disclosures Data (22-23)\nTPA Details\nVolo Health\nToll Free Number :\n1800202022\nEmail Address :\nassistance@volohealthtpa.com\ncashlesseverywhere@volohealthtpa.com\nsupport@volohealthtpa.com\ncashless@volohealthtpa.com\nCashless everywhere\nReimburse","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"cashlesseverywhere@volohealthtpa.com","label":"Volo Health TPA Cashless Email","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"losures Data (22-23)\nTPA Details\nVolo Health\nToll Free Number :\n1800202022\nEmail Address :\nassistance@volohealthtpa.com\ncashlesseverywhere@volohealthtpa.com\nsupport@volohealthtpa.com\ncashless@volohealthtpa.com\nCashless everywhere\nReimbursement claim registration\nClaim tracker","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"support@volohealthtpa.com","label":"Volo Health TPA Support Email","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"202022\n,\n1800220102\n,\n080-28004114/18004257878\nEmail address-\ninfo@mediassistindia.com\n,\ncontact.phs@paramounttpa.com\n,\nsupport@volohealthtpa.com\n,\ncustomersupport@healthindiatpa.com\n,\nhelp@vidalhealthtpa.com\n,\nFor claim registration of other policies (\nSaral Surak","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"cashless@volohealthtpa.com","label":"Volo Health TPA Cashless Email","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"1800202022\nEmail Address :\nassistance@volohealthtpa.com\ncashlesseverywhere@volohealthtpa.com\nsupport@volohealthtpa.com\ncashless@volohealthtpa.com\nCashless everywhere\nReimbursement claim registration\nClaim tracker/status for all type of claims.\nVolo Health Insurance","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"customersupport@healthindiatpa.com","label":"HealthIndia Insurance TPA Email","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"004114/18004257878\nEmail address-\ninfo@mediassistindia.com\n,\ncontact.phs@paramounttpa.com\n,\nsupport@volohealthtpa.com\n,\ncustomersupport@healthindiatpa.com\n,\nhelp@vidalhealthtpa.com\n,\nFor claim registration of other policies (\nSaral Suraksha Bima\n,\nPravasi Bhartiya Bima Yoja","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"preauth@healthindiaindiatpa.com","label":"HealthIndia Insurance TPA Preauth Email","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"pa.com/CustomerCorner/ClaimStatus.aspx\nToll Free Number :\n1800220102\nEmail Address :\ncustomersupport@healthindiatpa.com\npreauth@healthindiaindiatpa.com\nCashless everywhere\nReimbursement claim registration\nClaim tracker/status for all type of claims.\nHealthIndia Insurance","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"help@vidalhealthtpa.com","label":"Vidal Health Insurance TPA Email","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"o@mediassistindia.com\n,\ncontact.phs@paramounttpa.com\n,\nsupport@volohealthtpa.com\n,\ncustomersupport@healthindiatpa.com\n,\nhelp@vidalhealthtpa.com\n,\nFor claim registration of other policies (\nSaral Suraksha Bima\n,\nPravasi Bhartiya Bima Yojana\n,\nGroup Hospital Cash\n,","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"claims@rahejaqbe.com","label":"Claims email for two wheeler bundled policy","level":null,"hours":null,"applies_to":"motor","source_url":"https://rahejaqbe.com/uploads/images/tw-bundle/pdf/download/tw-bundle-_Prospectus-V01.pdf","quote":"800-102-7723 or in writing at the nearest Offices or through an intermediary.\n• Alternatively, you can also reach us at claims@rahejaqbe.com You can report with vehicle/ report claim at network garage whereby claim registration shall be done by network garage","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"18001027723","label":"Claims call centre","level":null,"hours":"Monday to Saturday, 9 am to 8 pm","applies_to":"all","source_url":"https://rahejaqbe.com/claims","quote":"ims!\nExplore\nCommercial Lines Claims\nClick here\nto track you claim status\nClick here\nto Register a Claim\nIntermediaries\n18001027723\ncustomercare@rahejaqbe.com\nContact Us\nHospital\nLocator\nGarage\nLocator\nRegister\na Claim\nRegister\nComplaint With Us\nPolic","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800-4259-449","label":"Medi Assist TPA Toll Free Number","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"p Up\n,\nArogya Sanjeevani\n,\nGroup Health Insurance\n,\nGroup Health Super Top Up\n) kindly contact our TPA.\nContact number-\n1800-4259-449\n,\n9122-66620808\n,\n1800202022\n,\n1800220102\n,\n080-28004114/18004257878\nEmail address-\ninfo@mediassistindia.com\n,\ncontact.","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"9122-66620808","label":"Paramount TPA Toll Free Number","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"njeevani\n,\nGroup Health Insurance\n,\nGroup Health Super Top Up\n) kindly contact our TPA.\nContact number-\n1800-4259-449\n,\n9122-66620808\n,\n1800202022\n,\n1800220102\n,\n080-28004114/18004257878\nEmail address-\ninfo@mediassistindia.com\n,\ncontact.phs@paramounttpa","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800202022","label":"Volo Health TPA Toll Free Number","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"Health Insurance\n,\nGroup Health Super Top Up\n) kindly contact our TPA.\nContact number-\n1800-4259-449\n,\n9122-66620808\n,\n1800202022\n,\n1800220102\n,\n080-28004114/18004257878\nEmail address-\ninfo@mediassistindia.com\n,\ncontact.phs@paramounttpa.com\n,\nsuppor","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800220102","label":"HealthIndia Insurance TPA Toll Free Number","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"ance\n,\nGroup Health Super Top Up\n) kindly contact our TPA.\nContact number-\n1800-4259-449\n,\n9122-66620808\n,\n1800202022\n,\n1800220102\n,\n080-28004114/18004257878\nEmail address-\ninfo@mediassistindia.com\n,\ncontact.phs@paramounttpa.com\n,\nsupport@volohealtht","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"080-28004114/18004257878","label":"Vidal Health Insurance TPA Toll Free Number","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"Health Super Top Up\n) kindly contact our TPA.\nContact number-\n1800-4259-449\n,\n9122-66620808\n,\n1800202022\n,\n1800220102\n,\n080-28004114/18004257878\nEmail address-\ninfo@mediassistindia.com\n,\ncontact.phs@paramounttpa.com\n,\nsupport@volohealthtpa.com\n,\ncustomersupport@he","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800-102-7723","label":"Call centre for claims intimation","level":null,"hours":"9 am to 8 pm, Monday to Saturday","applies_to":"all","source_url":"https://rahejaqbe.com/uploads/images/two-wheeler-package/pdf/download/tw-package-prospectus-V01.pdf","quote":"ct numbers specified in the Schedule to the Policy.\n• Intimation of claim can also be made to Raheja QBE Call centre at 1800-102-7723 or in writing at the nearest Offices or through the intermediary.\n• Alternatively, you can also reach us at customercar","fetched_at":"2026-10-20"}],"how_to_use":"Ask the user for each field in order, in plain words; never invent an answer. Labels are as printed. If fillable_pdf is true, pdf_fields gives the PDF's own field names so the file can be filled directly. The printed form decides if anything differs.","url":"https://indiainsurances.com/forms/raheja-qbe-general-insurance/1089-claim-form-ability-shield-insurance-policy"}