{"id":2330,"title":"Claim Form – Wage Compensation Policy - Group","purpose":"claim","insurer":{"slug":"raheja-qbe-general-insurance","name":"Raheja QBE General Insurance Co. Ltd."},"source_pdf":"https://rahejaqbe.com/uploads/images/wage-compensation/pdf/download/wage-compensation-claim-form-V01.pdf","sha256":"25380737c8fbc606064a4032219ca7a0788fcdd194f0d38aecc2280bb0727817","pages":6,"collected":"2026-10-17","instructions":{"about":"This form is used by the claimant or policyholder to file a claim under the Wage Compensation Group Insurance Policy. It collects details about the policy, claimant, accident, 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","Use original bills and documents as applicable","Authorization letter required if another party is handling the claim","Medical Attendant’s Certificate must be completed by the treating doctor","Employer must complete the certification section"],"title":"Claim Form – Wage Compensation Policy - Group","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 date of policy period","type":"date","label":"Policy Period: From","options":[],"required":null,"pdf_field":""},{"help":"Enter 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":"Full 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":"","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":"Landline phone number","type":"phone","label":"Phone No:","options":[],"required":null,"pdf_field":""},{"help":"Select if policy is issued in named or unnamed basis","type":"choice","label":"Policy issued Name or Unnamed basis","options":["Named","Unnamed"],"required":null,"pdf_field":""}],"filled_by":""},{"title":"Claimant’s Details","fields":[{"help":"Name of the 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":"Claimant's 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":"Landline phone number","type":"phone","label":"Phone No:","options":[],"required":null,"pdf_field":""},{"help":"Relationship of claimant to insured person","type":"text","label":"Relationship with Insured Person:","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":"Gender of the insured person","type":"text","label":"Sex:","options":[],"required":null,"pdf_field":""},{"help":"Date of birth of the insured person","type":"date","label":"Date of Birth:","options":[],"required":null,"pdf_field":""}],"filled_by":""},{"title":"Accident and Claim Details","fields":[{"help":"ID number of the employee/member","type":"text","label":"Employee/Member Identification No:","options":[],"required":null,"pdf_field":""},{"help":"Select all applicable benefits for the claim","type":"checkbox","label":"Claims under Which Benefits (Tick against the benefit)","options":["Sickness Hospitalization Cash","Accident Hospital Cash","Accidental Death","Day Care Procedure Cash","Convalescence Benefit","Loss of Income","International Emergency Benefit","Time Deductible","Double benefit option"],"required":null,"pdf_field":""},{"help":"Date when the 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 where accident happened","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":"6 digit postal code","type":"number","label":"Pin code:","options":[],"required":null,"pdf_field":""},{"help":"Describe the circumstances of the accident","type":"text","label":"How did Accident occur?","options":[],"required":null,"pdf_field":""},{"help":"Indicate if police was informed","type":"yes-no","label":"Was it reported to Police?","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 are present","type":"yes-no","label":"Are there any witnesses to the accident?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Describe injuries from the accident","type":"text","label":"Details of Injuries Sustained","options":[],"required":null,"pdf_field":""},{"help":"Type of disablement caused","type":"text","label":"Nature of disablement:","options":[],"required":null,"pdf_field":""},{"help":"Severity or extent of disablement","type":"text","label":"Extent of disablement:","options":[],"required":null,"pdf_field":""},{"help":"Start date of total disability","type":"date","label":"Period of 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 that cannot be performed 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":"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 postmortem was done","type":"yes-no","label":"Was postmortem conducted?","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":""},{"help":"Details of doctor consulted post-accident","type":"text","label":"Hospitalization/Treatment details: Name, Address, and contact details of Medical Practitioner consulted after the accident","options":[],"required":null,"pdf_field":""},{"help":"Details of usual doctor of insured person","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 details 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 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":""},{"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":""},{"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":null,"pdf_field":""}],"filled_by":"insured/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 identification number","type":"text","label":"Employee ID No:","options":[],"required":null,"pdf_field":""},{"help":"Policy number","type":"text","label":"covered under Disability Income Protected Group Insurance Policy No","options":[],"required":null,"pdf_field":""},{"help":"Leave start date","type":"date","label":"was on leave for the period","options":[],"required":null,"pdf_field":""},{"help":"Leave end date","type":"date","label":"To","options":[],"required":null,"pdf_field":""},{"help":"Sum insured amount","type":"amount","label":"Mr./Mrs. 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 date of accident was","options":[],"required":null,"pdf_field":""},{"help":"Employer authorized signatory signature","type":"signature","label":"Signature of Authorized signatory","options":[],"required":null,"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":"text","label":"Company Seal:","options":[],"required":null,"pdf_field":""}],"filled_by":"employer"},{"title":"Medical Attendant’s Certificate","fields":[{"help":"Duration of acquaintance with patient","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?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Patient's 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 matches claim","type":"yes-no","label":"Is the injury consistent with claimant’s description of the accident?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Indicate if injuries relate to prior conditions","type":"yes-no","label":"Are the injuries connected with any previous accident, infirmity, or disease?","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":"Indicate if recovery delayed","type":"yes-no","label":"Will the recovery be retarded due to above?","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 if treatment ongoing","type":"yes-no","label":"Are you still treating the patient for the injury/disability?","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 if admitted","type":"text","label":"If the patient was hospitalized, please give name of the hospital","options":[],"required":null,"pdf_field":""},{"help":"Surgery details if applicable","type":"text","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?","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 time","type":"yes-no","label":"Was the patient under the influence of intoxicants 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)","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)","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":null,"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":"Doctor's 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":"text","label":"Please affix official seal/stamp","options":[],"required":null,"pdf_field":""}],"filled_by":"medical attendant"}],"deadlines":[],"applies_to":"Wage Compensation Policy - Group claims","attachments":["Duly completed Claim Form signed by Insured/ Nominee","Claimant’s Statement - brief details of accident/illness","Photocopy of Policy Schedule /Certificate of Insurance","Copies of medical documents supporting the disability and treatment taken","Original Investigation Reports and copies of reports, X-Ray films supporting accidental injury","Post-Operative X-ray films if any","Bills and receipt towards expenses relevant to funeral ceremony / repatriation of mortal remains","Copy of Photo ID and Address Proof of Insured Member","Authorization Letter if authorizing another party to handle the 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) of the proposer","MLC/FIR Report/Postmortem Report (if applicable and conducted) duly attested","Proof of loss of income (Applicable for Loss of income cover, if opted). Salary Slip for Salaried person and proof of occupation for self-employed person"],"declarations":["I warrant the truth of foregoing statement and declare no material information is suppressed or concealed","I understand false declarations may result in refusal of claim payment","I authorize any hospital, physician or medical provider to furnish RQBE details of medical history/treatment as required"],"dropped_labels":2},"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/2330-claim-form-wage-compensation-policy-group"}