Get Ny Combined Insurance Claims Made Easy 2018-2026

Filling out the NY Combined Insurance Claims Made Easy form online is a straightforward process that can help expedite your claim payments. This guide provides detailed steps to ensure you complete each section of the form accurately.

Follow the steps to successfully complete your claim form.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Complete Section A of the form by providing your full name, mailing address, social security number, and policy number. Make sure that all information is accurate and up to date.
3. If you are filing a claim for an accident, describe the nature of the injuries in Section B, and provide details such as the date, time, and location of the accident.
4. If your claim is related to sickness, fill in the symptoms and diagnosis in Section B. Provide the necessary medical details which may include hospitalization dates.
5. In Section C, your employer needs to complete the Employer’s Statement for claims related to disability. Ensure they verify your employment and the nature of your disability.
6. The attending physician must fill out Section D completely, including their diagnosis and treatment dates. This section is crucial for supporting your claim.
7. Review your completed form for accuracy. Sign and date the Fraud Notification on page 5 to prevent delays.
8. For final submission, save the changes, download a copy for your records, and submit the form as instructed in your mailing options or preferred method.

Submit your claim form online today for faster processing and payment.