Get Oh Osysa Accident Medical Claim Form 2020-2025

Filling out the OH OSYSA Accident Medical Claim Form online can seem overwhelming, but with this guide, you will be well-equipped to complete the necessary steps accurately and efficiently. This comprehensive guide ensures that you understand each section of the form and helps facilitate your claim process.

Follow the steps to successfully complete your claim form.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred document editor.
2. Begin with Section I by filling in the claimant's name (last, first, and middle), date of birth, home address, and the type of claimant. Also, include the accident date and a description of the injury, specifying left or right as needed.
3. Indicate whether the accident occurred during a game, practice, tournament, indoor soccer, or while traveling to or from an activity. Then, detail how and where the accident occurred, including the name of the field or facility.
4. Proceed to Section II, where you will provide statistical information such as the name of the local association, club, age division, and time of day. Include the location of the incident, disposition, surface type, and condition.
5. In Section III, have the coach or a local official verify the incident by signing the verification section.
6. Section IV requires an authorized state official to sign, confirming the claimant's registration status at the time of the accident. Ensure their name and title are printed correctly.
7. Fill out Section V with the parent or guardian’s information, including names, addresses, phone numbers, and employer details. If the claimant has other insurance, provide that information as well.
8. In Section VI, sign the certification and authorization to release information, confirming that all details are accurate and complete.
9. Once all sections are properly completed, review the form for accuracy, and save your changes. You may choose to download, print, or share the form as necessary.

Complete your OH OSYSA Accident Medical Claim Form online today to ensure a smooth claim process.