{"id":840,"title":"PERSONAL ACCIDENT - CLAIM FORM","purpose":"claim","insurer":{"slug":"narayana-health-insurance","name":"Narayana Health Insurance Ltd."},"source_pdf":"https://stgaccinwbsprdlrs01.blob.core.windows.net/nhilprd/Personal_Accident_claim_form_1_ac876bfa06.pdf?sv=2025-05-05&spr=https&st=2025-09-18T07%3A40%3A23Z&se=2035-09-16T07%3A40%3A23Z&sr=b&sp=r&sig=VWRheLLM5CB%2BHn4P0II5mVlWAmuhidU6lmACte1QIww%3D","sha256":"509b374163c9ceadb5cae20b7bbcc01938f2f07930cc3cac31c835e217ce5841","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is used by the policyholder, nominee, or claimant to file a personal accident insurance claim with Narayana Health Insurance Limited.","notes":["Photocopy of Aadhaar Card or Aadhaar card number is required for all claims","KYC documents are mandatory for claims of 1 lakh and above","Cancelled cheque or bank statement/passbook copy must be attested by bank for NEFT payment","Claim form must be duly filled and signed","Medical certificate must be filled by registered doctor","Use original documents where specified"],"title":"PERSONAL ACCIDENT - CLAIM FORM","submit":{"to":"Narayana Health Insurance Limited","how":"","address":"Registered Office: No. 258/A, Bommasandra Industrial Area, Anekal Taluk, Bangalore - 560099, Karnataka, India"},"purpose":"claim","sections":[{"title":"INFORMATION ON ACCIDENTAL DEATH AND PERMANENT DISABILITY","fields":[{"help":"Enter the date of death if applicable","type":"date","label":"Date of death:","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"ACCIDENT WITNESS DETAILS","fields":[{"help":"Enter full name of the witness","type":"text","label":"Name of the witness:","options":[],"required":null,"pdf_field":""},{"help":"Enter phone number of the witness","type":"phone","label":"Contact number:","options":[],"required":null,"pdf_field":""},{"help":"Enter full address of the witness","type":"text","label":"Address:","options":[],"required":null,"pdf_field":""},{"help":"Enter city of the witness","type":"text","label":"City:","options":[],"required":null,"pdf_field":""},{"help":"Enter state of the witness","type":"text","label":"State:","options":[],"required":null,"pdf_field":""},{"help":"Enter postal pin code of the witness","type":"number","label":"Pin:","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"MEDICAL CERTIFICATE (TO BE FILLED BY REGISTERED DOCTOR)","fields":[{"help":"Doctor to provide details of disability if applicable","type":"text","label":"DETAILS OF DISABILITY (IF APPLICABLE)","options":[],"required":null,"pdf_field":""}],"filled_by":"registered doctor"}],"deadlines":[],"applies_to":"Personal accident claims including accidental death, permanent disability, temporary total disablement, and child education benefit","attachments":["Duly filled NEFT (National Electronic Funds Transfer) form","Duly Filled KYC (Know Your Customer) form and KYC documents (ID and address proof e.g PAN Card, Aadhaar Card, Ration Card, Passport etc) for all claims where claim amount is 1 lakh and above","Photocopy of Aadhaar Card/ Aadhaar card number for all claims","Death Certificate from Municipal Corporation (for Accidental Death claims)","FIR or MLC Copy (for Accidental Death and Permanent Total Disablement claims)","Post Mortem Report or Cause of death certificate from treating doctor (for Accidental Death claims)","Cancelled cheque copy in the name of nominee or bank statement / 1 page of passbook copy attested by bank (for NEFT payment)","Last Income tax return (ITR) (for Accidental Death claims)","KYC form along with photocopy of any one KYC document of nominee or payee (proposer) for claims amounting INR 1 lakh and above","Blood analysis report or Histopathology or Chemical viscera (If done) (for Accidental Death claims)","Disability Certificate from Government Hospital (for Permanent Total Disablement claims)","All treatment papers and Investigation report (for Permanent Total Disablement claims)","Outstanding loan statement from financer in case of 100% disability (for Permanent Total Disablement claims)","Copy of discharge card/summary (for Temporary Total Disablement claims)","Copy of investigation reports like X-RAY / MRI / CT scan etc (for Temporary Total Disablement claims)","Fitness certificate from treating doctor (for Temporary Total Disablement claims)","Leave certificate from employer (if salaried) / ITR of last 2 years (if own business) (for Temporary Total Disablement claims)","Birth Certificate of the child/ Aadhaar Card of the child/ Ration Card (for Child Education Benefit claims)","School ID card (for Child Education Benefit claims)","Copy of Fee receipt of school/college (for Child Education Benefit claims)"],"declarations":[],"dropped_labels":0},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"email","value":"support@narayanahealth.insurance","label":"Customer Support Email","level":1,"hours":null,"applies_to":"all","source_url":"https://www.narayanahealth.insurance/cashless-claim","quote":"yana Aditi\nArya Health Insurance\nContact us\nCall : +91-9821034071\nToll-Free for Senior Citizens : 1800 2030 234\nE-mail: support@narayanahealth.insurance\nLegal\nIRDAI customer education\nInsurance ombudsman\nPrivacy notice and disclaimers\nTerms of use\nUnderwriting policy\nWhis","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"+91-9821034071","label":"Customer Support","level":1,"hours":null,"applies_to":"all","source_url":"https://www.narayanahealth.insurance/cashless-claim","quote":"download the Cashless Claim Form\nView / Download\nRetail Products\nNarayana Aditi\nArya Health Insurance\nContact us\nCall : +91-9821034071\nToll-Free for Senior Citizens : 1800 2030 234\nE-mail: support@narayanahealth.insurance\nLegal\nIRDAI customer education\nI","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"claims@narayanahealth.insurance","label":"Claims Email","level":null,"hours":null,"applies_to":"health","source_url":"https://www.narayanahealth.insurance/reimbursement-claim","quote":"y hospital (network or non-network)\n2\nIntimate us within 24 hours of hospitalisation by calling\n+91 9821034071\nor email\nclaims@narayanahealth.insurance\n3\nPay the total bill amount at the time of discharge\n4\nSubmit the original claim documents (see checklist below) to the","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/narayana-health-insurance/840-personal-accident-claim-form"}