Helper Insurance Claims Advice

To ensure prompt claim processing, it is important that you submit a completed claim form, if applicable, some insurers may only require receipts/medical evidence; in addition, you will also be required to provide the following supporting documentation depending on the nature of your claim:

Outpatient / Dental Claim

• Original medical expenses receipt(s) issued by registered medical practitioner and/or bonesetter showing, among others, the name of patient, date of visit, type of treatment, the diagnosis, etc.
• The policy number and the name of the Insured shown at the back of the original medical expenses receipt(s).

Hospitalisation Claim

• Original hospital medical bill(s), receipt(s) with itemised breakdown of all expenses incurred.
• All medical records, report(s) showing the diagnosis and/or the operation(s) performed, certified by the attending medical practitioner.
• Medical practitioner’s written referral for laboratory tests / X-ray / treatment of physiotherapy or chiropractor, if applicable.

Employees' Compensation Claim

According to the Employees’ Compensation Ordinance, an employer must notify the Commissioner for Labour of any accident or prescribed occupational disease within the following notice periods, irrespective of whether the accident or the occupational disease gives rise to any liability to pay compensation:

If the employer is not aware of the happening of the accident within the respective periods, he must notify the Commissioner for Labour within 7 or 14 days, as the case may be, after the accident came to his knowledge.

Any employer who, without reasonable excuse, fails to give notice of an accident or makes or furnishes any false or misleading statement to the Commissioner for Labour commits an offence and is liable to a maximum fine of HK$50,000.

Employee Compensation claims will be settled as follows:

1. Direct Payment by Employer

If the accident incapacitates the employee for not more than 3 days and does not result in permanent incapacity, the employer should make compensation for temporary incapacity (payment for sick leave for work injury) on the employee’s normal pay day. The employer should also pay the medical expenses concerned.

2. Agreement between Employer and Employee

For the injury involving only temporary incapacity for a period exceeding 3 days but not more than 7 days, the employer may directly agree with the employee as to the compensation payable under the Ordinance and make such payment on or before the employee’s normal pay day. The employer should also pay the medical expenses concerned.

3. “Certificate of Compensation Assessment” issued by the Commissioner for Labour

For other cases, the Commissioner for Labour will assess the compensation payable under the Ordinance and issue to the employer and the employee a Certificate of Compensation Assessment (i.e. Form 5) stating the amount of compensation payable. If the injury results in temporary incapacity only, the certificate will be issued after sick leave clearance. If the injury is likely to result in permanent loss of earning capacity, the employee concerned will be referred to the Employees’ Compensation Assessment Board for assessment and the certificate (i.e. Form 5) will be issued after the Certificate of Assessment (i.e. Form 7 or 8) is issued by the Assessment Board. Any objection to the compensation assessment by either party must be made in writing to the Commissioner for Labour within 14 days after the issue of certificate, with a copy of the objection notice sent to the other party. On receipt of the objection notice, the Commissioner for Labour will review its assessment and issue a Certificate of Review of Compensation Assessment (Form 6) to both parties.

The employer should pay the employee, within 21 days from the date of issue of the certificate, the amount of compensation, or any outstanding amount, stated in the certificate. The employer should also pay the medical expenses concerned.

Please Note: Remember not to answer any correspondence, admit liability or enter into any settlement agreement without our prior consent.

Please note that the above are general claim guidelines, further information can be provided upon request.