Get Nira Proof Of Loss

Filling out the NIRA Proof Of Loss form is an essential step for individuals participating in NIRA-approved rodeo events to report and claim for any accidents. This guide provides clear, step-by-step instructions to help you accurately complete the form online.

Follow the steps to successfully complete your NIRA Proof Of Loss form.

1. Click the ‘Get Form’ button to obtain the NIRA Proof Of Loss form and open it in your preferred editor.
2. In the first section, provide your N.I.R.A. member number and indicate your region. Make sure to fill out the name of the insured person under the 'Name of insured person' field.
3. Enter the policy number, which is NO0191334. Select the type of activity by checking one of the options provided - either N.I.R.A. Approved Rodeo or N.I.R.A. Sanctioned Practice.
4. Fill in your social security number, gender, birthday, and contact information including address and phone number.
5. Provide your parents’ name, address, and phone number, as well as the date of the accident and the date of first treatment, along with the name of the attending physician.
6. Indicate the town and arena where the accident occurred, along with detailing the nature of injuries sustained, describing the parts of the body affected.
7. In detail, describe how the accident happened. Ensure that you provide comprehensive information, as it must relate to a bodily injury caused by an accident.
8. State the name of the rodeo activity or event you were participating in during the accident.
9. If hospitalized, list the name and address of the facility where treatment was received and include the dates of hospitalization.
10. In the second section, indicate whether you have other medical insurance. If you do, provide the name of the policyholder, policy number, and details of the insurance carrier.
11. Sign the form where indicated, authorizing the payment of benefits to the provider and allowing access to medical records. A witness signature is also required.
12. Complete the verification section by having your rodeo coach or regional faculty director confirm your participation in the event where the injury occurred.
13. After thoroughly reviewing all filled sections, save your changes, then download, print, or share the completed form as necessary.

Complete your NIRA Proof Of Loss form online today to ensure your claim is processed promptly.