Claims
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What you need to file your claim:
- Travel Itinerary: Complete copy of Official Travel itinerary which lists names of travelers, dates of travel, cost of fare which is issued from your travel agent, online booking website, Common Carrier, or Lodging. (i.e. flight schedule, hotel confirmation, and/or tour/cruise itinerary)
- Proof of payment(s) for the trip: i.e. itemized travel invoice, e-ticket or paper ticket, hotel charges, service fees, and other accommodation expenses and credit card statements.
- Accident/Incident report, if available. (required for automobile accidents)
- Police Report/Supporting Article: Copies of all police reports, newspaper articles, etc. describing accident.
- Certified copy of death certificate: Certified copy of death certificate. (required for all claims)
- Completed Medical Authorization form: A completed Medical Authorization for each treating medical facility. (HIPAA)
- Medical Records/Notes: i.e. Admission/Discharge Summary, Physician’s Notes, UB-04 Form, etc.
- Medical Bill Statement/Invoice: If the policyholder has no other insurance, need original medical bills that include the date of service, billed amount, type of service, and diagnosis.
- Explanation of Benefits: If the insured has insurance, we need the final disposition from the primary insurer listing payment or denial of claim. (EOB)
- Receipt/Proof of Payment for Medical Expenses: Copies of invoices and/or receipts for Medical Expenses incurred.
Note: Cash/Cashier receipts are not eligible for reimbursement or consideration. - Government Issued Photo Identification
- Travel Itinerary: Complete copy of Official Travel itinerary which lists names of travelers, dates of travel, cost of fare which is issued from your travel agent, online booking website, Common Carrier, or Lodging. (i.e. flight schedule, hotel confirmation, and/or tour/cruise itinerary)
- Proof of payment(s) for the trip: i.e. itemized travel invoice, e-ticket or paper ticket, hotel charges, service fees, and other accommodation expenses and credit card statements.
- Confirmation of delay: Documentation from the common carrier (airline, cruise line, etc.) confirming the delay.
- Confirmation of length of delay: Documentation from the common carrier (airline, cruise line, etc.) confirming the length of time the luggage was delayed.
- Itemized copy of the receipts: An itemized copy of the receipts for essential items purchased during the baggage delay. The receipts must provide proof of the following: place of purchase, date of purchase, items purchased. (Essential items are defined as "necessary personal effects" - i.e. needed clothing and toiletries that were contained in the bag that was delayed)
- Copy of delivery invoice: Copy of delivery invoice showing charge for delivery, if applicable.
- Government Issued Photo Identification
- Travel Itinerary: Complete copy of Official Travel itinerary which lists names of travelers, dates of travel, cost of fare which is issued from your travel agent, online booking website, Common Carrier, or Lodging. (i.e. flight schedule, hotel confirmation, and/or tour/cruise itinerary)
- Itemized copy of the receipts: An itemized copy of the receipts for essential items purchased during the baggage loss. The receipts must provide proof of the following: place of purchase, date of purchase, items purchased. (Essential items are defined as "necessary personal effects" i.e. needed clothing and toiletries that were contained in the baggage loss)
- Police Report: Copy of police report.
- Government Issued Photo Identification
- Travel Itinerary: Complete copy of Official Travel itinerary which lists names of travelers, dates of travel, cost of fare which is issued from your travel agent, online booking website, Common Carrier, or Lodging. (i.e. flight schedule, hotel confirmation, and/or tour/cruise itinerary)
- Accident/Incident Report: If available.(required for Automobile Accidents)
- Completed Medical Authorization Form: A completed Medical Authorization for each treating medical facility. (HIPAA)
- Medical Records: i.e. Admission/Discharge Summary, Physician’s Notes, UB-04 Form, etc.
- Medical Bill Statement/Invoice: If the policyholder has no other insurance, need original medical bills that include the date of service, billed amount, type of service, and diagnosis.
- Explanation of Benefits: If the insured has insurance, need the final disposition from the primary insurer listing payment or denial of claim. (EOB).
- Receipt/Proof of Payment for Medical Expenses: Copies of invoices and/or receipts for Medical Expenses incurred. Note: Cash/Cashier receipts are not eligible for reimbursement or consideration.
- Government Issued Photo Identification
- Travel Itinerary: Complete copy of Official Travel itinerary which lists names of travelers, dates of travel, cost of fare which is issued from your travel agent, online booking website, Common Carrier, or Lodging. (i.e. flight schedule, hotel confirmation, and/or tour/cruise itinerary)
- Proof of payment(s) for the trip: i.e., itemized travel invoice, e-ticket or paper ticket, hotel charges, service fees, and other accommodation expenses and credit card statements.
- Police/Incident report: Copy of the Police Report and/or copy of the incident report (filed with Rental Agency) showing loss date, driver information, vehicle information, renter/driver statement which explains accident details.
- Proof of Insurance: Driver's Insurance Declarations page.
- Rental Agreement: Copy of Rental Agreement.
- Demand Letter/Invoice from Rental Agency: Copy of the demand letter or invoice from the Rental Agency.
- Itemized estimate of damages/repairs: Itemized estimate of damages/repairs.
- Photographs of the damages.
- Proof of payment for damages.
- Fleet Log: Report from Car Rental Company that summarizes what rental vehicles were available for rent at the time the Insured’s rental vehicle was being repaired, or the receipt showing the Car Rental Company paid for the repairs to the vehicle. The fleet utilization log must be location and class specific and will detail the utilization rate for each day claimed.
- Government Issued Photo Identification
- Travel Itinerary: Complete copy of Official Travel itinerary which lists names of travelers, dates of travel, cost of fare which is issued from your travel agent, online booking website, Common Carrier, or Lodging. (i.e. flight schedule, hotel confirmation, and/or tour/cruise itinerary)
- Proof of payment(s) for the trip: i.e. itemized travel invoice, e-ticket or paper ticket, hotel charges, service fees, and other accommodation expenses and credit card statements.
- Confirmation of the reason: Confirmation of the reason for the Trip Cancellation, Interruption, or Delay. (i.e. completed physician statement, confirmation of death of immediate family member, or documentation confirming any other medical cause of loss)
- Cancellation letter from Travel Supplier: Cancellation letter from tour operator/agency/carrier (with cancellation policies).
- Travel Supplier Penalty Terms: Penalty terms from the affected travel company, carrier, lodging, or other provider.
- Documentation showing any refunds, if applicable.
- Additional/out of pocket expense receipts: Receipts for any additional/out of pocket expenses.*(a)
- Physician Statement: Physician Statement/form signed by Physician.
- Government Issued Photo Identification
*(a)Note: Reimbursement of same is limited by policy terms and conditions.
- Travel Itinerary: Complete copy of Official Travel itinerary which lists names of travelers, dates of travel, cost of fare which is issued from your travel agent, online booking website, Common Carrier, or Lodging. (i.e. flight schedule, hotel confirmation, and/or tour/cruise itinerary)
- Proof of payment(s) for the trip: i.e. itemized travel invoice, e-ticket or paper ticket, hotel charges, service fees, and other accommodation expenses and credit card statements.
- Confirmation of the reason: Confirmation of the reason for the Trip Cancellation, Interruption, Delay, or Missed Connection. (i.e. Common carrier cancellation or delay notices, news articles describing loss or event, or documentation confirming any other non-medical cause of loss, etc.)
- Cancellation letter from Travel Supplier: Cancellation letter from tour operator/agency/carrier (with cancellation policies).
- Travel Supplier Penalty Terms: Penalty terms from the affected travel company, carrier, lodging, or other provider.
- Documentation showing any refunds, if applicable.
- Additional/out of pocket expense receipts: Receipts for any additional/out of pocket expenses incurred as a result of the delay. *(a)
- Government Issued Photo Identification
*(a)Note: Reimbursement of same is limited by policy terms and conditions.
Claims Support
Have a question about your claim or want a claim form sent to you?
Call:
800-567-3512 (within US)
610-977-3224 (Puerto Rico)
Email: aci247@acitpa.com
Support available: M-F 7am-8pm (ET)