Claims documentation

DEATH

 

General information

The date of the occurrence of the death insured event is the date mentioned as such on the Death Certificate.

Necessary documents for the settlement of the claim file

  • Death certificate (issued by the Civil Service Hall or Community Public Service for People, only based on the Medical Certificate ascertaining the Death. The original document can be found at the Civil Service Hall or Community Public Service for People from where the heirs can request a copy of this one).
  • The Medical Certificate ascertaining the Death (can be obtained from the specialist/MD/coroner who ascertained the death).
  • Medical documents to prove the existence of the illness (medical records issued by the general or attending physician, the hospitalization note, the test results attesting the date of each diagnostic established prior to attaching the insurance).
  • The ID of the insured person's successor.

 

DEATH OUT OF ACCIDENT

 

General information

It is considered as an accident any fortuitous, unpredictable, violent, external event, which occurs independently of the insured person's will, directly and independently of any physical or mental illness, which determines physical injuries which lead to his/her death.

The date of the occurrence of the death insured event is the date mentioned as such on the Death Certificate.

Necessary documents for the settlement of the claim file

  • Death certificate (issued by the Civil Service Hall or Community Public Service for People only based on the Medical Certificate ascertaining the Death. The original document can be found at the Civil Service Hall or Community Public Service for People from where the heirs can request a copy of this one).
  • The Medical Certificate ascertaining the Death (can be obtained from the specialist/MD/coroner who ascertained the death).
  • The autopsy report (only if it is requested to you; this one can be obtained from the Forensic Institute which performed the autopsy).
  • The result of the Police, Court or Territorial Labour Inspectorate' investigation, as well as the alcohol/drug test Certificate of the insured person, if this one has been imposed by law.
  • The ID of the insured person's successor(s), if the case.
  • A document which should attest the quality as heir of the contact person (if the case).
  • The succession deed, in case of several heirs (if the case).
  • The heir(s)' bank statement (if the case).

 

TOTAL AND PERMANENT DISABILITY

 

General information

The total and permanent disability represents the injury as a result of an illness, ascertained by the social security doctor, which totally prevents you from performing activities which would bring you an income, a salary, gains or profit in any activity/profession and which determines your invalidity retirement (degree I or II according to Law no. 263/2010).

The date of the occurrence of the Total and Permanent Disability insured event is the date of the Decision on working capacity, issued by the social security expert physician, based on Law no. 263/2010.

Necessary documents for the settlement of the claim file

  • Medical decision on the working capacity (issued by the Public Pension National Authority. The decision must be the initial one, issued in the first year of retirement/occurrence of the disability).
  • Medical documents detailing the reasons which caused the permanent disability (hospitalization notes, report of the attending or expert physician).
  • Medical documents to prove the existence of the illness (medical records issued by the general or attending physician, the hospitalization note, the test results attesting the date of each diagnostic established prior to attaching the insurance).
  • Your ID.

 

TOTAL AND PERMANENT DISABILITY OUT OF ACCIDENT

 

General information

The total and permanent disability represents the injury as a result of an accident, ascertained by the social security doctor, which totally prevents you from performing activities which would bring you an income, a salary, gains or profit in any activity/profession and which determines your invalidity retirement (degree I or II according to Law no. 263/2010).

It is considered as an accident any fortuitous, unpredictable, violent, external event, which occurs independently of the insured person's will, directly and independently of any physical or mental illness, which determines physical injuries which lead to your Total and Permanent Disability.

The date of the occurrence of the Total and Permanent Disability insured event is the date of the Decision on working capacity, issued by the social security expert physician, based on Law no. 263/2010.

Necessary documents for the settlement of the claim file

  • Medical decision on the working capacity (issued by the Public Pension National Authority. The decision must be the initial one, issued in the first year of retirement/occurrence of the disability).
  • Police report (issued by the Police or the authorities who were present at the moment of the insured event's occurrence and drafted the report).
  • Medical document attesting the direct causality between the accident and the disability degree (if the case).
  • Report of the Territorial Labour Inspectorate (in case of a work accident, it is issued by the Territorial Labour Inspectorate or by the employer).
  • Your ID.

 

INVOLUNTARY UNEMPLOYMENT

 

General Information

The Involuntary Unemployment represents the termination of the individual labour contract, which causes you to become unemployed, in the meaning of the definition below.

Unemployed is considered any person whose individual labour contract with the employer terminated rightfully or at the employer's initiative, and who is registered with the Territorial Employment Agency, so that he/she benefits of an unemployment indemnity as an insured person within the system of the state social security and of the health social security.

The date of the occurrence of the Involuntary Unemployment insured event is the date mentioned as such in the AJOFM/ALOFN decision of granting the unemployment benefit.

Necessary documents for the settlement of the claim file

  • Working permit or certificate issued by the employer/ Territorial Labour Inspectorate in compliance with the provisions of Decision no. 500/2011 regarding the drafting and the completion of the employees' general book.
  • Decision to terminate the individual labour contract (issued by your last employer).
  • Document which shows that you are registered with the Employment Agency (it can be obtained from the County/Local Employment Agency/).
  • The unemployed person's record book endorsed and stamped monthly, or the monthly receipt showing the collection of the unemployment indemnity (the continuity of this event shall be proven by you, at least once a month).
  • Your ID.

 

TEMPORARY DISABILITY

 

General information

Temporary disability represents your temporary disability as a result of an accident or an illness ascertained by the physician, which prevents you from performing a professional/working activity which generates an income, provided that, until the first day of the activity's interruption, you have performed such professional/working activities which generate an income.

The date of the occurrence of the Temporary Disability insured event is the date mentioned in the document attesting this state, meaning the medical certificate.

Necessary documents for the settlement of the claim file

  • Certificate issued by the employer attesting your social-professional statute at the date of the insured event's occurrence.
  • Sick leave certificates, attesting the temporary disability, issued by a specialist physician or by a medical unit certified according to the valid legislation, where that diagnostic is mentioned (the persistence of this state shall be proven by you at least once a month).
  • Your medical records/ medical certificate signed and issued by your MD/attending physician showing the exact date of each diagnostic /the medical history at the moment of attaching the insurance.
  • The hospitalization notes, in case you have been in hospital (they can be obtained from the medical unit where you have been hospitalized).

In case the temporary disability occurred as a result of an accident, we can request the following documents:

  • Police report (issued by the Police or the authorities who were present at the moment of the insured event's occurrence and drafted the report).
  • Report of the Territorial Labour Inspectorate (in case of a work accident, it is issued by the Territorial Labour Inspectorate or by the employer).
  • Affidavit detailing the circumstances in which the event occurred. This statement is required only if there is no report drafted by the competent authorities).
  • Your ID.

 

HOSPITALIZATION AS A RESULT OF AN ACCIDENT

 

General information

The hospitalization as a result of an accident is the situation where the insured person has the quality of a hospitalized patient, following a direct and unmediated accident, for a continuous period of time.

It is considered as an accident any fortuitous, unpredictable, violent, external event, which occurs independently of your will, directly and independently of any physical or mental illness, which determines physical injuries which lead to your hospitalization, as a hospitalized patient.

The date of the occurrence of the insured event is the date mentioned on the admission note issued by the Hospital where you have been hospitalized.

Necessary documents for the settlement of the claim file

  • Hospital discharge note (it can be obtained from the medical unit where you have been hospitalized).
  • Police report (issued by the Police or the authorities who were present at the moment of the insured event's occurrence and drafted the report).
  • Report of the Territorial Labour Inspectorate (in case of a work accident, it is issued by the Territorial Labour Inspectorate or by the employer).
  • Your ID.