Get Claim Report - Purdue University - Purdue

This guide provides a comprehensive overview of how to complete the CLAIM REPORT for Purdue University. Following these instructions will help ensure you submit the form accurately and efficiently for prompt review and processing.

Follow the steps to complete the CLAIM REPORT effectively.

1. Click the ‘Get Form’ button to obtain the CLAIM REPORT and open it in the editor.
2. Begin by completing 'Part 1' of the form. Attach all relevant itemized bills associated with services rendered, including those from doctors, hospitals, and prescriptions.
3. In 'Part 2', enter the Policy Holder as 'Purdue University' and fill in the required details such as the serial number, name of the camp or group, dates of insurance coverage, and the patient's personal information including their name, date of birth, age, and sex.
4. Provide the home address of the patient, including city, state, and zip code.
5. Fill out the injury report section. Document the date of injury, the category of the patient (camper, counselor, salaried staff, etc.), and any relevant work compensation eligibility.
6. In the illness report section, state the time and date symptoms were first noticed and describe the group activity the individual was involved in.
7. Detail the nature of the illness or injury and explain comprehensively how and where the injury occurred.
8. Indicate whether the condition was pre-existing by checking 'Yes' or 'No' and providing further explanations in the space provided if applicable.
9. Confirm if medical treatment was not sought during the insured period and whether the injury or illness was reported to a staff member.
10. In 'Part 4', you will certify the event by selecting your role (camp director, chaperone, etc.), and enter your contact information, title, and signature.
11. In the 'Risk Management Only' section, authorize payments by selecting the appropriate payment option and filling in necessary payee information.
12. Finally, review all entered information for accuracy. Save your changes, then download, print, or share the form as needed.

Complete the CLAIM REPORT online today for efficient processing.