Work Injury Claim

As part of our continuous efforts to enhance digitalisation, we are pleased to inform that claims submission of all classes can be done online. Please note that from 1 December 2021, ERGO no longer accept hardcopy claim forms.

Notice

From 1 January 2020:

  • Changes in compensation and medical expenses limits.
  • Expand mandatory insurance coverage to non-manual employees, regardless of where they work.
  • Expand scope of compensation to include light duties.
  • Compulsory reporting for any instance of medical leave or light duties issued for work accident.

Statutory Notice:

  • Any employer who fails to make an incident report as required by the law may be fined up to $5,000 for a first offence. For a second or subsequent offence, the penalty will be up to $10,000 or 6 months’ jail, or both.
  • Failure to pay compensation is an offence, punishable by a fine up to $15,000 or jail up to 12 months, or both.

For complete information kindly visit MOM Website https://www.mom.gov.sg/workplace-safety-and-health/work-injury-compensation

Documents Upload (PDF for Documents and JPG for Photographs)

Reporting of Accidents

Fatal You must notify Ministry of Manpower as soon as possible and submit Ireport within 10 days from date of accident
Non-fatal You must submit Ireport within 10 days from date you were first notified of the accident
  • Photocopy of injured employee’s identity card and/or work permit (front and back).
  • Pay slips to support the injured employee’s salary for the 12 calendar months prior to the accident. (Earnings during the month of the accident and the month the injured employee joined cannot be considered and/or any incomplete monthly salary).
  • Medical report and/or Hospital Inpatient Discharge Summary and/or Physician’s Memo.
  • Incident report signed by safety officers or equivalent.
  • Photographs and/or CCTV if possible
  • Medical invoices and/or medical certificates.
  • If the injured person is not your direct employee, please submit the relevant contracts/documents to establish that the direct employer is your sub-contractor.
  • If the injured person is your direct employee and injured at a worksite of a project, please submit all the relevant contracts/documents relating to the project.

    Work Injury Claim Form

    Personal Information










    Claims Payment


    Please provide your bank details for faster claims processing. Once approved, your claim amount will be credited into your bank account.

    We will only credit into the Policyholder’s/Insured Person’s account.
    Notification of payment will be sent to your email address stated in your details. The company shall:
    (i) be discharged from all liability under this claim and
    (ii) not be liable for any and all losses incurred by you, as a result of you providing the company with inaccurate bank account number under this section for the payment of this claim.






    Description of Claims







    Have you made a claim against any other party in respect of this event? If yes, please provide details;




    I Agree




    Upload Supporting Documents


    If your medical claim value is above SGD$500, Please mail your original documents to Claims Department. For all other claims types You do not need to send us original documents, however we require you to keep all original documents for 6 months from the date of submission, in the event we need to sight them.

















    Declaration and Submission


    By submitting this claim form online, you:

    1. declare that the particulars stated above are true, accurate and complete and understand that if you have in this or in any further declaration in respect of this claim, made any false or fraudulent statement or suppress conceal or falsely state any material fact whatsoever my claim may be refused.
    2. authorise any person or organisation who has relevant information on this claim, including any medical practitioner, health care provider, insurance company and investigative agencies, to release and exchange such information (including personal health information) requested by ERGO Insurance and/or its claims service providers.
    3. authorise ERGO Insurance and its claims service providers to collect, use, disclose and/or process your personal data set out in this form and any other information provided by you or possessed by ERGO Insurance for the purpose of enabling ERGO to provide you with services required of an insurance provider, such as evaluating, processing, administering, and/or managing of your relationship and policies with ERGO Insurance. This includes among other things policy servicing, processing, investigating, handling, administering and/or settling your claim with ERGO or other insurers.
    4. understand that ERGO Insurance may/will disclose and transfer your personal data to third parties, including but not limited to its affiliates, representatives, agents and third party service providers, lawyers/law firms, whether located within or outside Singapore, for one or more of the above purposes, and the said third parties may/will subsequently collect, use, disclose and/or process your personal data for or more of the above purposes;
    5. accept that the personal data protection clauses herein are not exhaustive and you have read, understood and accept the terms of ERGO’s Personal Data Protection Policy at https://www.ergo.com.sg/pdpa;
    6. confirm that you are authorised to disclose information (including personal health information) about the insured person if this claim is made on behalf of them.
    7. confirm that you or the insured person is not claiming from any other insurance policy or on your or insured person's employment benefits provided by your or insured person’s employer.
    8. agree and accept that ERGO Insurance reserves the rights to contact the institution directly for validation of any submitted medical document’s authenticity and can request for the original bill/certified true copies whenever necessary within 1 year from the date of receipt of such medical document.
    9. understand and accept that ERGO Insurance can/may deny this or any related claims, recover any amounts disbursed, to impose additional charges or recovery any costs incurred in the event of fraudulent and/or multiple claims made.
    10. [ Authorization ] Where applicable, I/ We hereby authorize any hospital, clinic, physician or any other person to disclose all information including copies of all hospital or medical records on the patient when requested by ERGO Insurance Pte. Ltd. (ERGO). I have noted that any illness, injury, consultations, medical history, prescriptions or treatment the medical report fee incurred will be borne by me. A copy of this authorization shall be considered as effective and valid as the original.

    Please note that this procedure is only intended as a guide. Each claim submitted to ERGO will be reviewed based on its own merits in accordance with the concerned policy terms and conditions. We reserve our right to request for additional documents and/or information on a case-by-case basis.

    Kindly note that it may take longer to process a claim if we require additional information or documents from you. For any claims enquiry, amendment of details or submission of supporting or original documents, please email our friendly claims officers at onlineclaims@ergo.com.sg with our policy number.

    I Agree

        

    Imp Note: The acceptance of this online claim form does NOT constitute an admission of liability by ERGO Insurance Pte Ltd. or waiver of its rights.

    For enquiries

    ERGO Insurance Pte. Ltd.

    Email: claims@ergo.com.sg
    Phone: +65 6829 9199/ +65 98276193 (office hours)
    Fax: +65 6829 9247