Follow the steps to complete your claim form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Complete the Claim Form in its entirety, providing a detailed description of your accident along with responses to all other questions on the form. If you are filing a claim for a dependent, make sure to include their name in the designated field. Remember to sign and date the form, as well as the additional Information Release Authorization at the end of the form to allow WBA and your agent to assist with processing your claim.
3. Gather detailed billing statements from all medical providers. Also, obtain Explanation of Benefits (EOB) statements from any other insurance to accompany and match the medical bills you are submitting. Be aware that EOBs and 'Balance Due' bills alone are not acceptable. If requesting direct reimbursement for paid bills, ensure you have proof of payment, such as canceled checks or credit card statements.
4. Ensure you have all required documents to file your claim, including: - A completed and signed Accident Medical Claim Form with your WBA policy and member number - Explanation of Benefits (EOB) from any other insurance - Detailed medical bills from all providers - Proof of payment to medical providers if you are requesting direct reimbursement - Any other documentation related to the accident, such as a police report.
5. Send your completed claim form and all required documents to: Co-ordinated Benefit Plans P.O. Box 23802, Tampa, FL 33623-3802 Ensure you do not send original documents and retain copies for your records.
6. Follow up with Co-ordinated Benefit Plans (CBP) if they contact you for additional information or documentation. You can reach CBP at the provided phone number if you have any claim-related questions.

Begin your claim process by completing the CBP Claim - WBA AccidentShield online today!