Get Loss Of Use Claim Form - Polfed.org

Filling out the Loss Of Use Claim Form is a crucial step for individuals seeking to claim benefits following an accident. This guide provides a clear and structured approach to help users accurately complete the form online.

Follow the steps to efficiently complete your claim form.

1. Click the ‘Get Form’ button to retrieve the Loss Of Use Claim Form, opening it in an online editor of your choice.
2. Begin by filling in your full name, date of birth, division, rank, and personal identification number in the designated fields. Ensure that all details are accurate and current.
3. Provide your home address, email address, and telephone number. Double-check the spelling of your information to avoid any miscommunication.
4. Input the date and time of the accident, as well as the specific place where it occurred. A detailed description of the accident is important for your claim.
5. List the names and addresses of any witnesses who can corroborate your account of the accident.
6. Describe the nature of your injury clearly. If you have experienced a similar injury before, indicate if that is the case and provide relevant details.
7. Fill in your GP's contact details regarding the injury and your usual GP's information. Accurate medical details can expedite the processing of your claim.
8. Indicate the dates when you were totally and partially disabled from attending your usual occupation. If you are still disabled, provide an expected return date.
9. Answer if your disablement is solely due to the stated injury and provide further details if it is not.
10. Mention any prior physical defects or infirmities before the injury occurred.
11. Detail any other insurance benefits you might be entitled to, along with the name and address of the insurers or clubs.
12. A trustee of the insurance scheme must complete their section, certifying membership and coverage dates.
13. Sign the declaration stating that your information is true and complete. Read through any consent statements regarding medical reports carefully.
14. Complete the bank details section for direct payment upon approval of your claim, ensuring accuracy in your account information.
15. Once all fields are filled, review your information for any typos or missing entries. After verifying, save your changes, and choose to download, print, or share your completed form as needed.

Start your loss of use claim by filling out the form online today.