Get Claim Form - Azimuth Risk Solutions

Filling out the Claim Form for Azimuth Risk Solutions is a straightforward process that allows you to submit your medical claims efficiently. This guide provides a clear, step-by-step approach to ensure you accurately complete the form and submit all necessary information.

Follow the steps to complete your claim form accurately and effectively.

1. Click the ‘Get Form’ button to obtain the Claim Form - Azimuth Risk Solutions. The form will open for you to fill out.
2. In Part 1, identify whether the claim is related to an accident, dental accident, or illness/injury by selecting the appropriate checkbox. Provide the claimant's name, date of birth, policyholder's name, and complete mailing address for correspondence.
3. Include the contact information such as email, telephone number, and work telephone. Additionally, mention the citizenship and home country of the claimant along with their identification number.
4. State whether the claimant is a full-time student and, if yes, provide the name and address of the school. Indicate if this is a continuing claim and list the original dates of the initial claim form if applicable.
5. In Part 2, if the claimant is covered by another insurance plan, answer 'Yes' or 'No' to having additional insurance. If yes, provide the name of the primary insured, the insurance company's name, mailing address, and policy/group numbers.
6. Moving to Part 3, answer questions about how the condition or illness began, describe symptoms, and provide the date the first symptom appeared. Indicate if the claimant has been treated for this condition previously and provide details of all healthcare providers seen.
7. Continue providing information about whether the condition resulted from an accident, if it relates to a work accident, or involved a motor vehicle. If yes, include details such as names and contact information for involved parties.
8. For treatments that occurred outside the US, complete Part 4 by identifying the country, conditions, healthcare provider names and contact information, dates of treatment, total charges, and currency type.
9. Finally, in Part 5, verify all information is true and complete. Authorize the release of medical information to Azimuth and provide the signature of the insured or guardian along with the date.
10. Once all sections of the form are complete, review it carefully for accuracy. You can then save changes, download, print, and share the form as needed.

Complete your Claim Form - Azimuth Risk Solutions online today for efficient processing of your medical claims.