Get Accident Claim Form - Rod C. Adkins Insurance Service

Filling out the Accident Claim Form is an essential step to ensure that your claim is processed efficiently. This guide will provide you with clear, step-by-step instructions to assist you in completing the form online, helping to avoid any delays in your claim processing.

Follow the steps to successfully complete your form.

1. Click the ‘Get Form’ button to access the Accident Claim Form. This will allow you to open the document in an online editor where you can begin filling it out.
2. Complete Section A: Policyholder/Patient Information. Fill in the required fields including last name, first name, middle initial, date of birth, and contact details. Ensure that all information is accurate and current.
3. Indicate the type of claims being filed by checking all applicable boxes in the filing claim for section. This includes options such as accidental injury, hospitalization, disability, and life insurance.
4. If required, have your doctor complete Section B: Physician's Statement. Ensure that the physician includes all necessary information, such as diagnosis, treatment dates, and their signature.
5. For disability claims, have your employer fill out Section D: Employer's Disability Statement. This section requires verification of employment details and should be completed by your employer.
6. Collect and attach any required documents, including medical bills, police reports, and hospital records as indicated in the additional notes section. Ensure all documents are itemized and include necessary details supporting your claim.
7. Review all information to ensure completeness and accuracy. Sign the claim form at the bottom of Page 1 prior to submission.
8. Once all sections are completed and documents are attached, save your changes. You can then download, print, or share your completed form as needed to submit your claim.

Start your claim process today by completing the Accident Claim Form online.