{"id":2327,"title":"Claim Form","purpose":"claim","insurer":{"slug":"raheja-qbe-general-insurance","name":"Raheja QBE General Insurance Co. Ltd."},"source_pdf":"https://rahejaqbe.com/uploads/images/saral-suraksha-bima/pdf/download/saral-suraksha-claim-form-V01.pdf","sha256":"03a54729d1135c062ac4270f6e58a84f89abb53416b918c66c94d57901fa95a2","pages":8,"collected":"2026-10-17","instructions":{"about":"This form is used by the policyholder or claimant to file a claim under the Saral Suraksha Bima insurance policy. It collects details about the policy, claimant, accident, injuries, and treatment.","notes":["Answer all questions completely; use separate sheet if space is insufficient.","Issuance of form is not admission of liability.","Attach original bills and relevant documents as listed.","Disability certificate requirements vary by type of disability and must be issued by government doctors or authorized panels.","Employer section to be completed by employer only.","Medical Attendant’s Certificate must be signed and stamped by the attending doctor."],"title":"Claim Form","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":"Start date of policy period","type":"date","label":"Policy Period: From","options":[],"required":null,"pdf_field":""},{"help":"End date of policy period","type":"date","label":"To","options":[],"required":null,"pdf_field":""},{"help":"Name of the corporate policyholder","type":"text","label":"Corporate Name:","options":[],"required":null,"pdf_field":""},{"help":"Address of the corporate policyholder","type":"text","label":"Address:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City:","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:","options":[],"required":null,"pdf_field":""},{"help":"Email address","type":"email","label":"email","options":[],"required":null,"pdf_field":""},{"help":"Landline 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 of claimant","type":"email","label":"e-Mail:","options":[],"required":null,"pdf_field":""},{"help":"Claimant's address","type":"text","label":"Address:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City:","options":[],"required":null,"pdf_field":""},{"help":"Postal code","type":"number","label":"Pin code:","options":[],"required":null,"pdf_field":""},{"help":"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":"Mobile number of claimant","type":"phone","label":"Mobile No:","options":[],"required":null,"pdf_field":""},{"help":"Name of the insured person under the policy","type":"text","label":"Name of the Insured Person:","options":[],"required":null,"pdf_field":""},{"help":"","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":"Occupation or job nature of insured person","type":"text","label":"Occupation/Nature of Job:","options":[],"required":null,"pdf_field":""},{"help":"ID number of employee/member","type":"text","label":"Employee/Member Identification No.:","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Claims under Which Benefits","fields":[{"help":"Tick if claim is for death benefit","type":"checkbox","label":"Death","options":["Death"],"required":null,"pdf_field":""},{"help":"Tick if claim is for permanent total disability","type":"checkbox","label":"Permanent Total Disability","options":["Permanent Total Disability"],"required":null,"pdf_field":""},{"help":"Tick if claim is for permanent partial disablement","type":"checkbox","label":"Permanent Partial Disablement","options":["Permanent Partial Disablement"],"required":null,"pdf_field":""},{"help":"Tick if claim is for temporary total disablement","type":"checkbox","label":"Temporary Total Disablement","options":["Temporary Total Disablement"],"required":null,"pdf_field":""},{"help":"Tick if claim is for hospitalisation expenses","type":"checkbox","label":"Hospitalisation Expenses due to Accident","options":["Hospitalisation Expenses due to Accident"],"required":null,"pdf_field":""},{"help":"Tick if claim is for education grant","type":"checkbox","label":"Education Grant","options":["Education Grant"],"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":"Describe the injuries sustained","type":"text","label":"Nature of Injury","options":[],"required":null,"pdf_field":""},{"help":"Indicate if witnesses exist and provide their details if yes","type":"yes-no","label":"Are there any witnesses to the accident? Yes/ No, please provide contact Details of Witnesses.","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Name of witness","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"Address of witness","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"Phone number of witness","type":"phone","label":"Contact No.","options":[],"required":null,"pdf_field":""},{"help":"Email of witness","type":"email","label":"E-mail ID","options":[],"required":null,"pdf_field":""},{"help":"Indicate if police was informed","type":"yes-no","label":"Was it reported to Police? Yes No. If yes, please give the following details.","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":"MLC (Medico Legal Certificate) MLC report:","options":[],"required":null,"pdf_field":""},{"help":"Reason if police not informed","type":"text","label":"If no, please give reasons.","options":[],"required":null,"pdf_field":""},{"help":"Describe injuries sustained","type":"text","label":"Details of Injuries Sustained","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Disablement and Death Details","fields":[{"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":"Specify period of disablement","type":"text","label":"Period of_____________","options":[],"required":null,"pdf_field":""},{"help":"Start date of total disability","type":"date","label":"Total disability - Confined to bed: From","options":[],"required":null,"pdf_field":""},{"help":"End date of total disability","type":"date","label":"To","options":[],"required":null,"pdf_field":""},{"help":"Start date of partial disability","type":"date","label":"Partial disability - Confined to house: From","options":[],"required":null,"pdf_field":""},{"help":"End date of partial disability","type":"date","label":"To","options":[],"required":null,"pdf_field":""},{"help":"Describe duties not performable due to partial disability","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":"Current condition of incapacity","type":"text","label":"Present state of incapacity:","options":[],"required":null,"pdf_field":""},{"help":"Date of death if applicable","type":"date","label":"In case of death of the Insured Person: Date of death:","options":[],"required":null,"pdf_field":""},{"help":"Time of death with AM/PM","type":"text","label":"Time","options":[],"required":null,"pdf_field":""},{"help":"Indicate if post mortem was done","type":"yes-no","label":"Was post mortem conducted?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Reason if post mortem not conducted","type":"text","label":"If no, please give reasons.","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Hospitalization and Treatment Details","fields":[{"help":"Details of doctor consulted post-accident","type":"text","label":"Name, Address and contact details of Medical Practitioner consulted after the accident:","options":[],"required":null,"pdf_field":""},{"help":"Details of insured person's regular 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?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Hospital details if hospitalized","type":"text","label":"If yes, please give the name , address & contact of the hospital.","options":[],"required":null,"pdf_field":""},{"help":"Hospitalization start date","type":"date","label":"Period of hospitalization: From","options":[],"required":null,"pdf_field":""},{"help":"Hospitalization end date","type":"date","label":"To","options":[],"required":null,"pdf_field":""},{"help":"Estimated amount being claimed","type":"amount","label":"Estimated 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":""},{"help":"Details of other insurance policies covering claimant","type":"text","label":"Details of any other insurance (arranged by self, spouse, parents or employer) under which claimant/deceased is covered","options":[],"required":null,"pdf_field":""},{"help":"Attach proof of dependent children","type":"text","label":"Proof of number of Dependent Child / children substantiated by proof of identity documents","options":[],"required":null,"pdf_field":""},{"help":"Attach age proof documents for dependent children","type":"text","label":"Age proof of the Dependent Child / children","options":[],"required":null,"pdf_field":""},{"help":"Name of other insurer","type":"text","label":"Name of insurer","options":[],"required":null,"pdf_field":""},{"help":"Policy number of other insurance","type":"text","label":"Policy Number","options":[],"required":null,"pdf_field":""},{"help":"Insurance coverage period","type":"text","label":"Period of Insurance","options":[],"required":null,"pdf_field":""},{"help":"Coverage details","type":"text","label":"Coverage","options":[],"required":null,"pdf_field":""},{"help":"Sum insured under other policy","type":"amount","label":"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":true,"pdf_field":""},{"help":"Signature of claimant or insured person","type":"signature","label":"Signature of Insured/claimant","options":[],"required":true,"pdf_field":""}],"filled_by":"insured or claimant"},{"title":"Employer Certification","fields":[{"help":"Name of employee","type":"text","label":"Mr./Ms.","options":[],"required":null,"pdf_field":""},{"help":"Employee's designation","type":"text","label":"working as","options":[],"required":null,"pdf_field":""},{"help":"Employee ID number","type":"text","label":"Employee Id No.","options":[],"required":null,"pdf_field":""},{"help":"Group policy number","type":"text","label":"covered under Group Personal Accident Policy No.","options":[],"required":null,"pdf_field":""},{"help":"Leave period dates","type":"text","label":"was on leave for the period","options":[],"required":null,"pdf_field":""},{"help":"Sum insured amount","type":"amount","label":"is covered under the policy for a sum insured of Rs","options":[],"required":null,"pdf_field":""},{"help":"Number of employees on roll","type":"number","label":"The total number of employees on the rolls as on the date of accident was","options":[],"required":null,"pdf_field":""},{"help":"Signature of employer authorized signatory","type":"signature","label":"Signature of Authorized signatory","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date:","options":[],"required":true,"pdf_field":""},{"help":"Name and designation of signatory","type":"text","label":"Name & Designation of Authorized signatory:","options":[],"required":true,"pdf_field":""},{"help":"Company seal or stamp","type":"signature","label":"Company Seal:","options":[],"required":null,"pdf_field":""}],"filled_by":"employer"},{"title":"Medical Attendant’s Certificate","fields":[{"help":"Patient's full name","type":"text","label":"Name of Patient:","options":[],"required":true,"pdf_field":""},{"help":"Patient's occupation","type":"text","label":"Occupation:","options":[],"required":null,"pdf_field":""},{"help":"Confirm if usual doctor","type":"yes-no","label":"Are you his/her usual Medical Attendant?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Duration of acquaintance","type":"text","label":"How long have you known this patient?","options":[],"required":null,"pdf_field":""},{"help":"Confirm if injuries are only from accident","type":"yes-no","label":"Are the injuries solely due to the accident or traceable to any previous injuries / disease?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Describe injuries and extent","type":"text","label":"Kindly state the nature of and extent of injuries","options":[],"required":true,"pdf_field":""},{"help":"Confirm consistency with claimant's account","type":"yes-no","label":"Is the injury consistent with claimant’s description of the accident?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Confirm if injuries relate to previous conditions","type":"yes-no","label":"Are the injuries connected with any previous accident, infirmity or disease?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Details of previous injuries or disease","type":"text","label":"If yes, please provide details.","options":[],"required":null,"pdf_field":""},{"help":"Name of other doctors consulted","type":"text","label":"Please give details of other consultations – Doctor’s Name:","options":[],"required":null,"pdf_field":""},{"help":"Address of other doctors","type":"text","label":"Address:","options":[],"required":null,"pdf_field":""},{"help":"Contact number of other doctors","type":"phone","label":"Contact No.","options":[],"required":null,"pdf_field":""},{"help":"Confirm if treatment ongoing","type":"yes-no","label":"Are you still treating the patient for the injury/disability?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Details of treatment given","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 if admitted","type":"text","label":"If the patient was hospitalized please give name of the hospital.","options":[],"required":null,"pdf_field":""},{"help":"Hospitalization end date","type":"date","label":"To","options":[],"required":null,"pdf_field":""},{"help":"Indicate if recovery will be delayed","type":"yes-no","label":"Will the recovery be retarded due to above?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Details of factors delaying 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":"Details of surgery if performed","type":"text","label":"Date & Nature of surgical procedure, if any (dd/mm/yyyy)","options":[],"required":null,"pdf_field":""},{"help":"Indicate complications affecting recovery","type":"yes-no","label":"Are there any complication which may retard the recovery?","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 previous similar injuries","type":"yes-no","label":"Has the patient suffered from similar injury/disability previously?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Details of previous injury","type":"text","label":"If yes, when, nature and duration of the injury/disability.","options":[],"required":null,"pdf_field":""},{"help":"Indicate if patient was intoxicated","type":"yes-no","label":"Was the patient under the influence of intoxication or drugs at the time of accident?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Period of total disability","type":"text","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) to (dd/mm/yyyy)","options":[],"required":null,"pdf_field":""},{"help":"Period of partial disability","type":"text","label":"b. Partially disabled from performing his/her usual occupation From (dd/mm/yyyy) to (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 Give 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 qualification","type":"text","label":"Qualification","options":[],"required":true,"pdf_field":""},{"help":"Doctor's registration number","type":"text","label":"Registration No.","options":[],"required":true,"pdf_field":""},{"help":"Doctor's name","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"Doctor's address","type":"text","label":"Address","options":[],"required":true,"pdf_field":""},{"help":"Date of certificate","type":"date","label":"Date","options":[],"required":true,"pdf_field":""}],"filled_by":"treating doctor or medical attendant"}],"deadlines":[],"applies_to":"","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 the accidental injury","Post-Operative X-ray films, if any","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","Employee ID card","Credit card statement for the policy period","First Information Report and Final Police report (if necessary)","Bills and receipts for 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 (Photo ID with Address – Pan card, Aadhar card, CKYC form)","Hospital summary / Discharge Summary (for Hospital Daily Cash policy)","Final Hospital Bill with Bill break up and receipt (photocopy)","Disability certificate from Medical Practitioner or Hospital confirming extent and nature of disability","Hospital Treatment papers","Any other related documents"],"declarations":["The claimant warrants the truth of the statements and declares no material information is concealed.","False declarations may result in refusal of claim payment.","Authorization is given to hospitals and medical providers to furnish medical details to the insurer.","Claim may be refused if information is untrue, inaccurate or concealed.","Employer certifies the employee's details and leave period are true to the best of their knowledge.","Medical Attendant certifies the correctness of the medical information provided."],"dropped_labels":1},"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/2327-claim-form"}