CLAIM INFORMATION

An Accident has occurred which resulted in an injury and unexpected medical bills. How do you go about filing a claim?

Helpful Hints for Filing an Accident Medical Claim

1. Print out the correct claim form.

2. Print or type clearly on the claim form and try to refrain from using abbreviations for your city or county. Be specific in your description of what happened.

3. Attach all bills and any Explanation of Benefits from other insurance sources.

4. Make copies of everything that you send in to the claims processor.

5. Mail to the address in the upper left-hand corner of the claim form.

6. Give the claims office 2 weeks before calling to check the status of your claim.

7. Any additional bills and Explanation of Benefits received after filing your original claim, should be sent in along with a copy of the claim form to the address in upper left-hand corner of the claim form within 90 days of the date of service.

Please note that bills must be sent within 90 days of the date of service, to the company identified with the claimants name, school district (if applicable) and date of Accident. If you have other insurance, file simultaneous claims with your other insurance carrier to avoid delays in benefits payments.

Completion of a claim form does not guarantee benefit payment. Each claim is reviewed according to policy provisions.

Helpful Hints for Filing a General Liability Claim

1. Include a clear identification of all injured persons and others involved, including name, age, sex, address, phone number, social security number or driver license number (if available); identification & description of property damaged, specific location of the accident (including as much detail as possible such as reference to fixed identifiable objects showing distance and direction from such objects and movement of persons, vehicles or objects during the event).

2. Time and date of event; general activity of injured person(s); name and address of any witnesses; general conditions at the time of the event including surface conditions, lighting, noise, weather conditions, possible distractions and all other details obtainable.

3. Full identification of any vehicle or machinery involved, including make, model, serial or identification (ID) number.  A brief description of injuries and copies of any medical reports as well as any police, fire or accident reports available.

If a summons and complaint is received, call Special Markets (800) 727-7642 and overnight a copy of the complaint to the address shown on the General Liability Incident Report.  Any questions with regard to the status of a claim can be directed to Special Markets at the 800 number listed above.

Click on the link below to printout the claim form needed.

Accident Medical Claim Form

General Liability Incident Report

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The Home School Legal Defense Association (HSLDA) does not assume any of the insurance risk provided by QBE Insurance or Capitol Insurance, HSLDA is not involved in the administration of these plans including premium collection or adjudication of claims. HSLDA acts only in the capacity of the Master Policyholder for these Policies for its Members benefit.