Get Part A (policyholder's Statement) - Volstate

Filling out the PART A (POLICYHOLDER'S STATEMENT) for Volstate is an important step in managing your insurance claim. This guide is designed to provide you with clear and supportive instructions to ensure that you complete the form accurately and efficiently.

Follow the steps to successfully complete your PART A (POLICYHOLDER'S STATEMENT).

1. Press the ‘Get Form’ button to access the PART A (POLICYHOLDER'S STATEMENT) form and open it in the online editor.
2. In Section 1, input the employer's name. Ensure the details are correct to avoid processing delays.
3. Next, provide your email address in the ‘POLICYHOLDER’S E-MAIL ADDRESS’ field. Accurate contact information is crucial for communication purposes.
4. Fill out the ‘POLICYHOLDER’S NAME’ field with your full legal name as it appears on your policy.
5. Enter your ‘POLICY/CERTIFICATE NO.’ to identify your coverage accurately.
6. Provide your social security number in the designated field. This information is necessary for identification.
7. Input your date of birth, ensuring the format complies with required standards.
8. Indicate your sex in the appropriate field. This information may be required for demographic purposes.
9. Complete your address details in Section 2, including street, city, state, and zip code.
10. In Section 3, fill in the ‘CLAIMANT’S NAME’ with the person who is sick or injured. Their date of birth must also be included.
11. Indicate your relationship to the policyholder in Section 4. This helps clarify the connection for claim processing.
12. Provide the ‘POLICYHOLDER’S TELEPHONE NO.’ including the area code to enable further communication.
13. In Section 4, clearly describe when and how the accident occurred or the nature and onset of your illness.
14. State whether a worker's compensation claim has been filed and if the incident relates to your occupation.
15. Include the date when your symptoms first appeared to assist in processing your claim.
16. Discuss the doctor who treated or referred you within the last year, providing their contact details.
17. If hospitalized in the last year, include the relevant dates and details about the medical facility.
18. Review all completed sections to ensure accuracy before finalizing your claim submission.
19. Sign and date the authorization in Section 8. This certification is essential for processing your claim.
20. Finally, save your changes, and download, print, or share the completed form as needed.

Complete your documents online today to ensure your claim is submitted promptly.