Please note that bills must be sent to the company identified within 90 days of the date of service, 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.
Choose from below to fill out the form online:
Sentry Insurance
Mutual Of Omaha
Madison National
| » | Print out the correct claim form. |
| » | 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. |
| » | Attach all bills and any Explanation of Benefits from other insurance sources. |
| » | Make copies of everything that you send in to the claims processor. |
| » | Mail to the address in the upper left-hand corner of the claim form. |
| » | Give the claims office 2 weeks before calling to check the status of your claim. |
| » | 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. |
