{"id":2323,"title":"Claim Form – Disability Income Protect Group Insurance","purpose":"claim","insurer":{"slug":"raheja-qbe-general-insurance","name":"Raheja QBE General Insurance Co. Ltd."},"source_pdf":"https://rahejaqbe.com/uploads/images/rqbe-disability-income-protect-group/pdf/download/disability-income-protected-claim-form-V01.pdf","sha256":"d6e9738fda401b2f9b3e73078785fd9f0825ba41e84bc7584d5f8a25c4392aeb","pages":8,"collected":"2026-10-17","instructions":{"about":"This form is used by the claimant or insured person to file a disability income protection claim under a group insurance policy. It collects details about the policyholder, claimant, accident, injuries, 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.","Medical Attendant’s Certificate must be completed by the treating doctor.","Employer section to be completed by authorized signatory.","Attach all required documents as listed."],"title":"Claim Form – Disability Income Protect Group Insurance","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":"6-digit postal code","type":"number","label":"Pin code:","options":[],"required":null,"pdf_field":""},{"help":"Enter mobile phone number","type":"phone","label":"Mobile Number:","options":[],"required":null,"pdf_field":""},{"help":"Enter 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":"Tick whether policy is issued in named or unnamed basis","type":"choice","label":"Policy issued Name or Unnamed basis Named Unnamed","options":["Named","Unnamed"],"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":"Claimant's 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":"6-digit 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":"Specify relationship to insured person","type":"text","label":"Relationship with Insured Person:","options":[],"required":null,"pdf_field":""},{"help":"Full name of insured person","type":"text","label":"Name of the Insured Person:","options":[],"required":null,"pdf_field":""},{"help":"Select gender","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":""}],"filled_by":"claimant"},{"title":"Employee/Member Identification and Benefits","fields":[{"help":"ID number of employee/member","type":"text","label":"Employee/Member Identification No:","options":[],"required":null,"pdf_field":""},{"help":"Tick all applicable benefits for claim","type":"checkbox","label":"Claims under Which Benefits (Tick against the benefit)","options":["Death Permanent Partial Disability","Permanent Total Disability Temporary Total Disability","Terrorism Extension","Medical Expense Monthly Temporary Disability Income","Lump-sum Permanent Disability Income","Credit Card Minimum Amount Protection","Loan Protection","Personal Liability Assistance"],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Details of Accident","fields":[{"help":"Date when accident occurred","type":"date","label":"Date of Accident:","options":[],"required":null,"pdf_field":""},{"help":"Time of accident with AM/PM","type":"text","label":"Time:","options":[],"required":null,"pdf_field":""},{"help":"Location of accident","type":"text","label":"Place of Accident:","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 of accident location","type":"number","label":"Pin code:","options":[],"required":null,"pdf_field":""},{"help":"Describe how the accident happened","type":"text","label":"How did Accident occur?","options":[],"required":null,"pdf_field":""},{"help":"Indicate if police were informed","type":"yes-no","label":"Was it reported to Police? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"If reported, provide police station details","type":"text","label":"Name and address of Police Station:","options":[],"required":null,"pdf_field":""},{"help":"First Information Report number","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":""}],"filled_by":"claimant"},{"title":"Injuries and Disablement Details","fields":[{"help":"Describe injuries from accident","type":"text","label":"Details of Injuries Sustained","options":[],"required":null,"pdf_field":""},{"help":"Describe type of disablement","type":"text","label":"Nature of disablement:","options":[],"required":null,"pdf_field":""},{"help":"Describe extent of disablement","type":"text","label":"Extent of disablement:","options":[],"required":null,"pdf_field":""},{"help":"Dates for total disability period","type":"date","label":"Period of Total disability – Confined to bed: From To","options":[],"required":null,"pdf_field":""},{"help":"Explain which duties cannot be performed","type":"text","label":"If partially disabled, please give details of the daily duties of usual occupation that cannot be performed","options":[],"required":null,"pdf_field":""},{"help":"Date and time of death if applicable","type":"date","label":"In case of death of the Insured Person: Date of death Time","options":[],"required":null,"pdf_field":""},{"help":"Indicate if postmortem was done","type":"yes-no","label":"Was postmortem conducted? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Reason for no postmortem","type":"text","label":"If not, please give reasons","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Hospitalization and Medical Treatment Details","fields":[{"help":"Provide details of treating doctor after accident","type":"text","label":"Name, Address, and contact details of Medical Practitioner consulted after the accident","options":[],"required":null,"pdf_field":""},{"help":"Provide details of usual doctor","type":"text","label":"Name, Address, and contact details of Insured Person’s usual Medical practitioner","options":[],"required":null,"pdf_field":""},{"help":"Indicate if hospitalization occurred","type":"yes-no","label":"Was the Insured Person hospitalized following the accident? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Hospital details if hospitalized","type":"text","label":"If yes, please give the name, address & contact details of the hospital","options":[],"required":null,"pdf_field":""},{"help":"Hospitalization 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 convenient place and time for medical officer visit","type":"text","label":"Where and when can a Medical Officer of Raheja QBE visit you, if necessary?","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 the form","type":"signature","label":"Signature of Insured/Claimant","options":[],"required":true,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"To be completed by Employer","fields":[{"help":"Employee's designation","type":"text","label":"Working as","options":[],"required":null,"pdf_field":""},{"help":"Employee identification number","type":"text","label":"Employee ID No.","options":[],"required":null,"pdf_field":""},{"help":"Policy number under which employee is covered","type":"text","label":"Policy No","options":[],"required":null,"pdf_field":""},{"help":"Sum insured amount","type":"amount","label":"Sum insured","options":[],"required":null,"pdf_field":""},{"help":"Number of employees on rolls","type":"number","label":"Total number of employees on the rolls as on date of accident","options":[],"required":null,"pdf_field":""},{"help":"Employer's authorized signatory 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":"Affix company seal","type":"attachment","label":"Company Seal","options":[],"required":null,"pdf_field":""}],"filled_by":"employer"},{"title":"Medical Attendant’s Certificate","fields":[{"help":"Duration of doctor-patient 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 / disease?","options":[],"required":null,"pdf_field":""},{"help":"Describe injuries and extent","type":"text","label":"Kindly state the nature of and extent of injuries","options":[],"required":null,"pdf_field":""},{"help":"Confirm injury 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 previous related injuries","type":"yes-no","label":"Are the injuries connected with any previous accident, infirmity, or disease? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Details of previous injuries","type":"text","label":"If yes, please provide details","options":[],"required":null,"pdf_field":""},{"help":"Indicate if recovery delayed","type":"yes-no","label":"Will the recovery be retarded due to above? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Details on delayed recovery","type":"text","label":"If yes, kindly provide details","options":[],"required":null,"pdf_field":""},{"help":"Date of first consultation","type":"date","label":"When were you first consulted for this injury/disability (DD/MM/YYYY)","options":[],"required":null,"pdf_field":""},{"help":"Other doctors consulted","type":"text","label":"Please give details of other consultations - 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/disability? 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":"Complications details","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 at accident","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":"Start date of total disability","type":"date","label":"While under your care and direction, how long was or will the patient be: a. Totally unable to perform each and every duty of his/her usual occupation from (DD/MM/YYYY)","options":[],"required":null,"pdf_field":""},{"help":"Start date of partial disability","type":"date","label":"b. Partially disabled from performing his/her usual occupation from (DD/MM/YYYY)","options":[],"required":null,"pdf_field":""},{"help":"Details and percentage of permanent disability","type":"text","label":"c. Nature of disablement (in case of permanent disability) Permanent Total Disability – Yes No Permanent Partial Disability – Yes No Given details and percentage of disability","options":[],"required":null,"pdf_field":""},{"help":"Cause of death if applicable","type":"text","label":"In case of death of insured person, please give the cause of death","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/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":null,"pdf_field":""}],"filled_by":"treating doctor"}],"deadlines":[],"applies_to":"Disability Income Protect Group Insurance claims","attachments":["Duly completed Claim Form signed by Insured/ Nominee","Attending Physician’s Statement","Claimant’s Statement - brief details of accident/illness","Photocopy of Policy Schedule /Certificate of Insurance","Copies of medical documents supporting the disability and treatment","Original Investigation Reports and copies of reports, X-Ray films supporting accidental injury","Disability Certificate (optional as per insurer discretion)","Leave Records with seal and signature of Authorized signatory (for Employer Employee Group Policy)","Photocopy of 12 months’ Salary slips/ Form 16/26/ITR (as per insurer discretion)","Termination Employment Letter from Employer (if applicable)","Letter from employer certifying no payment during disability period","Employee ID card","Credit card statement for the policy period","First Information Report and Final Police report (if necessary)","Bills and receipts towards funeral ceremony / repatriation expenses","Loan Certificate/Amortization Schedule from Bank/Financial Institution","Death certificate (if 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 documents (Pan card, Aadhar card, CKYC form)"],"declarations":["I warrant the truth of foregoing statement and have not concealed any material information.","I understand false declarations may result in claim refusal by RQBE.","I authorize any hospital, physician or medical provider to furnish RQBE details of medical history/treatment."],"dropped_labels":6},"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/2323-claim-form-disability-income-protect-group-insurance"}