Get Accident Claim Form - Palm Beach State College

Filing an accident claim can be a straightforward process when you have clear guidance. This guide will help you navigate the completion of the Accident Claim Form for Palm Beach State College, ensuring your submission is accurate and expedient.

Follow the steps to successfully complete the Accident Claim Form.

1. Press the ‘Get Form’ button to access the Accident Claim Form and open it in the appropriate editor.
2. Provide the policyholder's information in the designated sections. This includes the policyholder number, name, address, college phone number, program name, time and date of the accident, and place of occurrence.
3. In the Policyholder Certification section, ensure that the policyholder official fully answers and signs each item, affirming the claim's validity and reading the Fraud Warning Certification statement.
4. Proceed to the Claimant/Student Certification section. This part must be completed by a parent/guardian or adult claimant, focusing on the claimant's name, gender, date of birth, and contact information. Make sure to accurately answer any medical coverage questions.
5. Read and understand the statement concerning Medicare and other medical policies. Check the appropriate responses to indicate the claimant's insurance status.
6. Review the certification requirements. The signing individual must attest that the information provided is accurate and has read the Fraud Warning Certification statement.
7. Complete the electronic Funds Transfer section, if applicable, by providing any necessary banking information.
8. Once all sections are filled out, save the document, and make a copy for your records. You can download, print, or share the completed form as needed.

Begin completing your Accident Claim Form online today for a smoother claims process.