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\r\nInjured Person
\r\n{\"Accident & Injury\"}
\r\nThe Earnings
\r\n{\"Payment & Submit\"}
\r\n| \r\n \r\n The injured employee is required to inform his employer of\r\n the accident as soon as practicable. The employer should\r\n send the employee for medical treatment as soon as possible.\r\n All medical fees and expenses should be paid by the\r\n employer. The employer is required to report the accident to\r\n the Commissioner of Workplace Safety and Health through the\r\n iReport System within the following reporting timeline, as\r\n well as notify his/her insurer(s),\r\n \r\n
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| \r\n \r\n \r\n Failure to report a work-related accident may prejudice\r\n your claim for indemnity under the Policy and is also an\r\n offence which carries a fine and/or jail term.\r\n \r\n \r\n | \r\n ||||||||||||
| \r\n \r\n If the doctor issues more MCs or light duty to the injured employee, the employer is required to update the incident report via the iReport system. \r\n \r\n | \r\n ||||||||||||
| \r\n \r\n The employer is required to pay the injured employee’s medical leave wages by the next payday upon receiving the original MCs.\r\n \r\n | \r\n ||||||||||||
| \r\n \r\n The employer is required to pay the medical expenses directly to the hospital or clinic.\r\n \r\n | \r\n ||||||||||||
| \r\n \r\n You must take care of your workers during their stay in Singapore, including providing adequate food and accommodation. Otherwise, your security bond may be forfeited.\r\n \r\n | \r\n ||||||||||||
| \r\n \r\n You cannot send your workers home against their wishes if they have an outstanding claim under the Work Injury Compensation Act (WICA).\r\n \r\n | \r\n ||||||||||||
| \r\n \r\n If the accident is a subject of claim under Common Law, you are to forward to Etiqa all letters that you have received, or may receive, from the lawyers for the workman and you must not, in any circumstances, admit liability in any manner.\r\n \r\n | \r\n ||||||||||||
| \r\n \r\n Claim may be rejected for non-reported or late reported claims and/or failure to provide complete documents as requested by Etiqa for their claim assessment.\r\n \r\n | \r\n
\r\n [Declaration]{\" \"}\r\n \r\n I/We declare that the information given in this form is true and\r\n correct to the best of my knowledge and belief. I/We understand\r\n that all information and supporting documents may be subject to\r\n review by Etiqa and Etiqa shall reserves all rights to recover\r\n any and all amounts if for any reason any claim is found to be\r\n fraudulent. Etiqa shall also reserve the right to pursue any\r\n actions at law or in equity that it deems appropriate in dealing\r\n with such fraudulent activity.\r\n \r\n
\r\n\r\n [Authorization]{\" \"}\r\n \r\n I/We hereby consent to and authorize the medical practitioner\r\n involved in the claimant’s care to discuss and disclose\r\n treatment details and discharge arrangements with and to Etiqa\r\n Insurance Pte Ltd. I/We agree that a copy of this consent shall\r\n have the validity of the original.\r\n \r\n
\r\n\r\n \r\n [Customer’s Data Privacy Consent]\r\n {\" \"}\r\n \r\n I/We further declared that the information written in this claim\r\n form or held by Etiqa Insurance Pte Ltd whether contained in\r\n my/our insurance application or otherwise obtained may be used\r\n and disclosed to your authorised staff, associated individuals\r\n and/or companies or any independent third parties (within or\r\n outside Singapore) who will provide claims administrative,\r\n advice and/or information or claims services in relation to\r\n my/our claim. I/We understand my/our data that may also be used\r\n for audit, business analysis and reinsurance purposes.\r\n \r\n
\r\n\r\n\r\n [Direct Credit]{\" \"}\r\n \r\n I/We confirm that there had not been any change to my tax\r\n residency status or any circumstances which affects my/our tax\r\n residency status and undertake to provide Etiqa with a suitably\r\n updated self-certification and documentation otherwise.\r\n \r\n
\r\n\r\n [Direct Credit]{\" \"}\r\n \r\n Confirm that the payment information provided by me/us in this\r\n form is true and correct and undertake to immediately inform the\r\n Company of any change in the same and will not hold the Company\r\n liable in the event that any payment transaction into my Account\r\n is delayed or cannot be effected due to incorrect or incomplete\r\n information being provided in this form, and/or for any other\r\n reason beyond the reasonable control of the Company.\r\n \r\n
\r\n\r\n [Direct Credit]{\" \"}\r\n \r\n Notwithstanding the above, Etiqa Insurance Pte Ltd reserves the\r\n right to release payment to me/us by cheque if we are unable to\r\n payout the claim by direct credit.\r\n \r\n
\r\n\r\n Please note: Total file size should not exceed 10MB.\r\n
\r\n\r\n Has exceeded the 10MB total file size limit. Please\r\n reupload another file with smaller size.\r\n
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