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Optional Accident Benefits Confirmation Form Increased Income Replacement If you cannot work as the result of a car accident, you may be eligible for weekly income replacement benefits for up to 104

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What is optional accident benefits confirmation?

Optional accident benefits confirmation is a form that confirms the selection or rejection of additional accident benefits coverage beyond the statutory minimums.

Who is required to file optional accident benefits confirmation?

Insured individuals who wish to select or reject optional accident benefits coverage are required to file the optional accident benefits confirmation form.

How to fill out optional accident benefits confirmation?

Optional accident benefits confirmation form can be filled out by indicating choices for optional accident benefits coverage and providing relevant personal information as required.

What is the purpose of optional accident benefits confirmation?

The purpose of optional accident benefits confirmation is to document the insured individual's choices regarding additional accident benefits coverage.

What information must be reported on optional accident benefits confirmation?

Personal information of the insured individual, choices for optional accident benefits coverage, and signature confirming the selection or rejection of additional coverage.

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