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Get Ing Accident Insurance Claim Form

0227, Columbia, SC 29202 Phone: 1-855-730-2902; Fax: 803-870-9252 CLAIM CHECKLIST Complete Sections 1, 2 and 3 Attach an itemized bill, Explanation of Bene ts (EOB) or other approved proof of injury and submit with this Claim Form to the address above. For an Off-Job Accident Disability Income Rider Claim: Also complete Sections 4 and 5. If you were hospitalized as a result of this accident, a separate Attending Physician s Statement must be completed and signed by your atte.

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