Get the free assurity accident claim form

ASSURING LIFE INSURANCE COMPANY Application for ACCIDENT BENEFITS Post Office Box 82533, Lincoln, NE 68501-2533 (800) 869-0355, Ext. 4484 Fax (800) 869-0368 Failure to complete this form in its entirety

How to fill out assurity accident claim form

How to fill out an assurity wellness claim:

1. Obtain the necessary claim forms from Assurity. These forms may be available on their website or through their customer service department.
2. Fill in the required personal information, such as your name, address, and policy number, on the claim form.
3. Provide details about the wellness activity or expense for which you are filing a claim. This may include the date of the activity, the provider's name, and a description of the services received.
4. Attach any supporting documentation that may be required, such as receipts or invoices from the wellness activity or expense.
5. Review the completed claim form and supporting documentation to ensure accuracy and completeness.
6. Submit the claim form and supporting documentation to Assurity by mail or through their online claims submission portal.
7. Keep copies of all submitted documents for your records.

Who needs an Assurity wellness claim:

1. Assurity wellness claims are generally needed by individuals who have Assurity insurance policies that include wellness benefits or reimbursement for certain wellness activities or expenses.
2. These individuals may have participated in a qualifying wellness program, undergone certain health screenings, or incurred expenses related to preventive care or wellness services.
3. It is important to review your insurance policy or contact Assurity directly to determine if you are eligible for wellness benefits and whether you need to file a wellness claim.

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What is assurity accident claim form?

The Assurity accident claim form is a document used to report and file an insurance claim for accidents covered under an insurance policy.

Who is required to file assurity accident claim form?

The individual who suffered an injury or damage due to an accident, or their legal representative, is required to file the Assurity accident claim form.

How to fill out assurity accident claim form?

To fill out the Assurity accident claim form, provide accurate details of the accident, personal information, any witnesses, medical treatment received, and necessary documentation such as police reports and medical records.

What is the purpose of assurity accident claim form?

The purpose of the Assurity accident claim form is to formally initiate the claims process, allowing the insurance company to evaluate the claim and determine eligibility for benefits.

What information must be reported on assurity accident claim form?

The information that must be reported includes the date and time of the accident, location, description of the events, involved parties and witnesses, injuries sustained, and any treatment received.