Get Il Mutual Bd-164 2017-2025

This guide will provide you with comprehensive instructions on how to complete the IL Mutual BD-164 form online. By following these steps, you will ensure that your accident insurance claim is submitted accurately and efficiently.

Follow the steps to successfully fill out the IL Mutual BD-164 online

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Complete the claimant's information section. Enter your name, date of birth, and select your gender and marital status. Indicate your relationship to the policy owner and check if you are a full-time student.
3. Provide the policy owner's information, including their name, address, contact number, and email address.
4. Fill out the accident information section. Enter the date of the accident, indicate whether it was an on-job or off-job accident, and record the date of your initial medical treatment. Provide a description of the accident.
5. Review the required documentation section. Ensure you have all necessary bills from medical services and any other relevant reports ready for submission.
6. If applicable, indicate any supplemental benefits you wish to file for by marking the corresponding box and following any additional instructions provided.
7. If claiming disability benefits due to an off-job accident, fill in the required details regarding your last date worked and returns to work.
8. Sign and date the claim form at the designated section. If the claimant is a minor, ensure that the parent or guardian signs on their behalf.
9. Review all entered information for accuracy. Once confirmed, save changes, download, print, or share the form as necessary.

Start filing your IL Mutual BD-164 online today to ensure a streamlined claims process.