Get Oh Osysa Accident Medical Claim Form 2019

Filling out the OH OSYSA Accident Medical Claim Form online can simplify the process of reporting an accident and seeking medical claims. This guide will provide clear, step-by-step instructions to ensure you complete each section accurately and efficiently.

Follow the steps to fill out the form correctly

1. Click ‘Get Form’ button to access the claim form and open it in your selected format.
2. Complete all questions in Section I, which includes providing details about the claimant, such as name, date of birth, home address, and accident date.
3. In Section II, enter statistical information regarding the accident including the local association, club name, age division, and details of the incident's location and condition.
4. For Section III, ensure that the coach or local official who witnessed the accident signs this section to verify the claim.
5. In Section IV, an authorized state official must certify that the claimant was a registered participant at the time of the accident. Their signature is required.
6. Fill out Section V with parent or guardian information, including contact details and any other insurance coverage the claimant may have.
7. Complete Section VI by signing the statement of certification and authorization to release information. This is crucial for processing your claim.
8. Once all sections are filled out correctly, save your changes and either download, print, or share the form as required.

Complete your claim form online today to ensure timely processing of your accident report.