Get 866 387 0484

Filling out the 866 387 0484 form online is a straightforward process that allows users to submit claims for accidents effectively. This guide will walk you through each section of the form, ensuring you provide all necessary information to expedite your claim.

Follow the steps to complete the accident claim form online.

1. Click ‘Get Form’ button to access the form online. This will open the necessary document in your web browser.
2. Begin by filling out Section 1, which includes your information as the claimant. Provide your last name, first name, address, city, state, ZIP code, policy number, and both day and night phone numbers. Specify your relationship to the policy owner as self, spouse, or dependent.
3. Move to Section 2, where you will detail the specific information regarding the accident. Enter the date of the accident, indicate if it was work-related, and provide the date of initial medical treatment. Additionally, note if the accident was covered by Workers’ Compensation and describe the claimant's role in the incident (driver or passenger).
4. Include additional details about the accident in the designated area. Describe how the accident occurred, what transpired, and when it happened. Provide the name and address of the hospital and doctor who treated you.
5. Proceed to Section 3 to authorize the release of your medical information. Sign and date the form as the claimant, or have a parent sign if the claimant is a minor. Be sure to include your relationship to the claimant.
6. After filling out the form, review all the information for accuracy. Gather any required attachments such as bills, accident reports, or medical records that need to accompany the form.
7. Finally, save your changes, and you may choose to download, print, or share the completed form as required. Ensure it is sent to the contact information provided at the top right of the form.

Complete your documents online today and ensure a smooth claims process.