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Get Accident Claim Form - Palm Beach State College

To the following address: Fringe Benefit Coordinators, Inc. P. O. Box 5249 Gainesville, FL 32627-5249 Toll Free Number (800) 654-1452 Fax Number (352) 372-9805 Policy underwritten by Hartford Life and Hartford Life and Accident Insurance Company Claimant administration handled by Fringe Benefit Coordinators, Inc. Step 1 - Submit a completed Notice of Claim (claim form) to our office either by fax or mail. The Policyholder (not the Parent, Claimant or Agent) should: Fully answer/sign e.

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