American Fidelity Accident Insurance Form

This form gives us authorization to get records from your medical provider s and others who may hold information necessary for us to review.

American fidelity accident insurance form. The claim form helps us identify what account the claim belongs to allows us to ensure we have updated or complete information and gives a description of the accident and injuries caused by the accident. We may also need. Download afmobile app for ios. Download afmobile app for android.

When filing an accident insurance claim you will need to provide medical records or office notes specific to the treatment of injuries due to your accident. Skip to main content coronavirus disease covid 19 developments. Accidents happen and come with unexpected costs. Authorization to disclose information including phi.

Office notes and or medical records from your medical provider. American fidelity understands the coronavirus is impacting the daily lives of our customers and is causing disruptions to those we serve. This form gives us authorization to get records from your medical provider s and others who may hold information necessary for us to review your claim. Accident insurance from american fidelity can help your employees cover out of pocket medical costs when trying to meet their deductibles.

Whether an employee is a weekend warrior with an active lifestyle or part of a busy family or simply living everyday life accidents can happen anytime. When filing an accident insurance claim you will need to provide medical records or office notes specific to the treatment of injuries due to your accident. A limited benefit accident only insurance policy may help lessen the impact. This form is part of the full critical illness claim form and is required to complete the claim process.

Print and mail a pdf or do it all online to make transfers update beneficiaries or complete other account related tasks. We may also need. What should i send with the completed claim form. You will complete the statement of insured on the first page then have the physician in charge of your care complete the remaining pages.