Get Print Form - Online Claim Center

This guide will provide you with a clear and supportive step-by-step process for completing the Print Form - Online Claim Center. Following these instructions will help ensure that your claim is submitted correctly and efficiently.

Follow the steps to complete the form successfully.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by selecting the type of claim you are submitting from the following options: hospital room indemnification, excess accident medical expense reimbursement, ambulance fee reimbursement, or accidental death. Mark the appropriate box.
3. Ensure to gather the following required documentation: the original signed claim form and medical authorization, a copy of your automobile insurance policy's declarations page, a complete police report, and the Accident Affidavit. These documents need to be attached when submitting your claim.
4. Fill in your personal information, including your name, address, and relationship to the policyholder. If you have other applicable insurance, provide details regarding those insurers.
5. Complete the incident details, including the date of loss and any necessary specifics about your accident. Provide a detailed account of how the accident occurred.
6. Sign and date the form to certify that all information is true and accurate. Ensure that you record the date of your signature as this is crucial for processing.
7. Finally, save changes made to the completed form. You can choose to download, print, or share the form as needed to accompany your claim submission.

Start filling out your documents online today to ensure your claim process is smooth and efficient.