With regard to the Insuree’s temporary disability, resulting from occupational or non-occupational accident, the following documents should be submitted:

1. Claim Request Form Л3-53 – an original
2. Accident Information Form Л3-53 – an original
3. Copy of the identity card of the eligible person for Life insurance and Group Risk Life insurance
4. Medical documents for rendered first aid and treatment conducted - discharge summary, outpatient cards, interpretation of imaging test results, tests, etc. - copies
5. Actually used sick leave notes: a primary one, the remaining - representing uninterrupted continuations, a copy with “True to the Original” inscription, ink-stamped and signed by the Employer. For persons with discontinued health insurance rights, as per the Social Security Code, a sick leave note is not to be submitted
6. An official document, containing the bank account of each and every heir, if it is not indicated in the Claim Request Form. 
7. Upon a road accident* – a Document from the control authorities that have visited the accident scene – a copy
8. Upon a road accident* – a Document for a taken blood sample for alcohol testing and its results, if the injured person is a vehicle driver – a copy
9. Upon individual insurance: Insurance policy
10. Upon group insurance at the Employer’s expense: Company Certificate from the Employer that the person is insured - an original
11. Upon group insurance at the Insurees’ expense: A copy of the insurance policy and a list of Insurees’ names

Upon a temporary disability due to an ACCIDENT AT WORK, the Insuree should provide the following additional documents:

1. Declaration Statement to the National Social Security Institute about an accident at work - a copy
2. NSSI order about an acknowledged accident at work - a copy

In case the sums will not be received by the eligible person:

Notarized power of attorney from the entitled person, if the sums will be received by another person. The power of attorney must contain a statement (text) that the eligible person has been notified that he is entitled to receive the sums in person.

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