File a Claim

Claim – Motor

1 Step 1

2 Step 2

3 Step 3

Motor Accident Claim Form
For any inquiry or clarification, call Commercial Insurance Motor Claims Department on 1280 or email us comins@commercialinsurance.com.lb
Insured’s Details
Driver’s Detail*
Accident Description*
Third Party Details*

To start, were you or anyone else injured and/or is receiving medical treatment as a result of this accident?
- Yes
- No
Insured Name*
Insured Address*
Mobile Number*
Insured Email
Insured policy #
Insured Policy Effective
Is policy holder driver of vehicle at time of accident ?
- Yes
- No

Vehicle Registration Number
Driver License Number
Vehicle Details
Vehicle Brand*
Plate Number*
Vehicle Usage*
Body Type*
Year of manufacture*
Horse Power*
Number of Seats*
Engine Number*
Classic Number*

Motor Insurance Plan
Requested Effective Date*
Bodily Injuri Coverage*
(Obligatory Motor Insurance – USD 500.000)
Material Damage Coverage (in USD)*

Claim – Medical

For any inquiry or clarification, call Commercial Insurance Medical Claims Department on 1280 or email us comins@commercialinsurance.com.lb
What are you claiming for?*
- EMERGENCY
- IN
- OUT
- REIMBURSEMENTS
OUT
Please submit the following documents at provider premises where NEXtCARE online system is deployed or at university hospitals where NEXtCARE nurse delegates are present or by fax to 01-498323 or email nc_claims.lb@nextcarehealth.com or upload here
1. 1. Copy of the insurance card
2. 2. Copy of insured ID
3. 3. Unified prescription mentioning the diagnosis dated, signed and stamped by a licensed physician adequately filed as per NSSF rules (too long? If so we can omit highlighted part)
4. 4. NSSF prior approval for tests requiring NSSF prior approval
Files
Drop files here or
IN
Please submit the following documents* at provider premises where NEXtCARE delegates are present or by fax to 01-498323 or email nc_claims.lb@nextcarehealth.com or upload here
1. 1. Copy of the insurance card
2. 2. Copy of insured ID
3. 3. Provider name
4. 4. Date of admission
5. 5. NSSF pre approval
6. 6. Related medical test results
Files
Drop files here or
EMERGENCY
Please present your Commercial Insurance card and your ID to the healthcare provider for immediate approval.
REIMBURSEMENTS
Please submit the following original documents to Commercial Insurance:
1. 1. Copy of the insurance card
2. 2. Copy of insured ID
3. 3. Original invoice & receipt of provider
4. 4. Original detailed medical report
5. 5. Original results
6. 6. For co-NSSF patients: Detailed NSSF bill, NSSF prior approval and receipt
Insured Name
Insured Address*
Insured Number
Insured Email
Policy Number
Policy Effective
Files
Drop files here or
Claims Details
- In
- Out
Claim Date
Claim Location
Symptom/Injury Description
Have you ever had similar symptom?
- Yes
- No
When did the first symptom appears ?
• When was the last time you consulted a doctor for similar symptoms?
Name of treaty doctor
First Last
Name of treaty physician
First Last
Doctor’s report
Copy of your medical card
Copy of your ID

Claim – Personal Accident

For any inquiry or clarification, call Commercial Insurance Medical Claims Department on 1280 or email us comins@commercialinsurance.com.lb
What are you claiming for?
- EMERGENCY
- IN
- OUT
- REIMBURSEMENTS
EMERGENCY
Please present your Commercial Insurance card, your ID , duly filled claim form or copy of the insurance policy to the healthcare provider for immediate approval.
IN
Please submit the following documents* at provider premises where NEXtCARE delegates are present or by fax to 01-498323 or email nc_claims.lb@nextcarehealth.com or upload here
1. 1. Copy of the insurance card
2. 2. Copy of insured ID
3. 3. Duly filled claim form or copy of the insurance policy
4. 4. Provider name
5. 5. Date of admission
6. 6. Detailed medical report MRA dated, signed and stamped by a licensed physician
7. 7. Related medical test results
Files
Drop files here or
OUT
Please submit the following documents at provider premises where NEXtCARE online system is deployed or at university hospitals where NEXtCARE nurse delegates are present or by fax to 01-498323 or email nc_claims.lb@nextcarehealth.com or upload here
1. 1. Copy of the insurance card
2. 2. Copy of insured ID
3. 3. Duly filled claim form or copy of the insurance policy
4. 4. Unified prescription mentioning the diagnosis dated, signed and stamped by a licensed physician adequately filed as per NSSF rules
Files
Drop files here or
REIMBURSMENTS
Please submit the following original documents to Commercial Insurance:
1. 1. Copy of the insurance card
2. 2. Copy of insured ID
3. 3. Duly filled claim form or copy of the insurance policy
4. 4. Original invoice & receipt Provider name
5. 5. Original detailed medical report
6. 6. Original results

Claim – Workmen’s compensation

For any inquiry or clarification, call Commercial Insurance Medical Claims Department at 1280 or email us comins@commercialinsurance.com.lb
What are you claiming for?
- EMERGENCY
- IN
- OUT
- REIMBURSEMENTS
EMERGENCY
Please present your Commercial Insurance card, your ID , duly filled claim form or copy of the insurance policy to the healthcare provider for immediate approval.
IN
Please submit the following documents* at provider premises where NEXtCARE delegates are present or by fax to 0-498323 or email nc_claims.lb@nextcarehealth.com or upload here
1. 1. Copy of the insurance card
2. 2. Copy of insured ID
3. 3. Duly filled claim form or copy of the insurance policy
4. 4. Provider name
5. 5. Date of admission
6. 6. Detailed medical report MRA dated, signed and stamped by a licensed physician
7. 7. Related medical test results
Files
Drop files here or
OUT
Please submit the following documents at provider premises where NEXtCARE online system is deployed or at university hospitals where NEXtCARE nurse delegates are present or by fax to 0-498323 or email nc_claims.lb@nextcarehealth.com or upload here
1. 1. Copy of the insurance card
2. 2. Copy of insured ID
3. 3. Duly filled claim form or copy of the insurance policy
4. 4. Unified prescription mentioning the diagnosis dated, signed and stamped by a licensed physician adequately filed as per NSSF rules
Files
Drop files here or
REIMBURSEMENTS
Please submit the following original documents to Commercial Insurance:
1. 1. Copy of the insurance card
2. 2. Copy of insured ID
3. 3. Duly filled claim form or copy of the insurance policy
4. 4. Original invoice & receipt Provider name
5. 5. Original detailed medical report
6. 6. Original results

Claim – Motor

Motor Accident Claim Form

Vehicle Details

Motor Insurance Plan

Claim – Medical

OUT

IN

EMERGENCY

REIMBURSEMENTS

Claim – Personal Accident

EMERGENCY

IN

OUT

REIMBURSMENTS

Claim – Workmen’s compensation

EMERGENCY

IN

OUT

REIMBURSEMENTS

Claim – Miscellaneous

Miscellaneous Claim Form