Insurance Claim Form – NEW

IMPORTANT, PLEASE READ: The claims process is not a fast turnaround; it could be 15-30 business days (or more) before the claimant hears from a claim’s examiner, and longer to receive reimbursement. The accident medical policy is secondary to the claimant’s personal primary insurance. The claimant should never put the accident medical policy number on physician’s office or hospital admissions paperwork. If the claimant does not have insurance, the claimant will report that they do not have insurance. If the claimant does have insurance, the claimant will provide their primary insurance card information. The accident medical policy is excess and for reimbursement of out-of-pocket medical bills. If the claimant receives a bill in the mail, the claimant needs to pay that bill or make payment arrangements. The claimant’s failure to pay a bill, and as a result, is sent to collections, falls solely on the claimant. If the claimant does get sent to collections, it will not make the claims team work harder or faster. The claimant needs to collect all medical bills and be ready to provide those bills to the claims examiner when requested.