Get Laa/uvg Minor Accident Declaration Form - Groupemutuel

Filling out the LAA/UVG Minor Accident Declaration Form online is essential for reporting minor accidents covered by Groupe Mutuel. This guide provides step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to successfully complete your online declaration form.

1. Click ‘Get Form’ button to obtain the form and open it for completion.
2. Provide the claim number in the designated field to identify your case effectively.
3. Select the appropriate accident insurer by checking the box for either Groupe Mutuel Assurances GMA SA or Mutuel Assurances SA.
4. Enter your employer's details, including the policy number and the injured person’s usual workplace.
5. Complete the injured person's section by entering their name, date of birth, civil status, nationality, contact information, profession, date of employment, and any details regarding other employers.
6. Indicate the date of the accident in the specified format (day/month/year).
7. Describe the site of the accident, including the location and city, for context.
8. In the facts section, provide a clear description of what the injured person was doing at the time of the accident, including any involved persons or objects.
9. If applicable, indicate the last time the injured person was at work prior to the accident, along with the reason for their absence.
10. Document any injuries, specifying the part of the body affected and the type of injury sustained.
11. List the names of the doctors or clinics that provided first aid and any follow-up treatments.
12. Complete the health insurance section by providing your city and date, then insert a stamp and signature where required.
13. Finally, ensure all sections are filled accurately, then save changes, and download, print, or share the completed form as needed.

Complete your LAA/UVG Minor Accident Declaration Form online today for prompt processing of your claim.