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CLAIM INFORMATION

How to File an Accident Medical Claim
How to File a General Liability Claim
Claim Tips

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

How to File an Accident Medical Claim

1. Print out the correct claim form.
2. Print or type clearly on the claim form.  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 (EOB) forms 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 (EOB) forms received after filing your original claim, should be sent in along with a copy of the claim form to the address in the upper left-hand corner of the claim form within 60 days of the date of service.

Please note that bills must be sent within 60 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.

OneBeacon Accident Medical Claim Form 

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How to file 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 or 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 policy, fire or accident reports available.

If a summons and complaint is received, call SMIC (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 SMIC at the 800 number listed above.

OneBeacon General Liability Claim Form 

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Claim Tips

In the event of an accident, follow these simple guidelines:
 

Accident Medical Expense Coverage under the Policy is provided on an Excess Basis and Benefits will only be paid under this plan after your own person or group insurance (including Health Maintenance Organizations) has paid out it's benefits.  Please note that you must follow your primary insurance carrier's eligibility criteria (i.e., to be treated in-network, if required by HMO, etc.) in order for the Policy to consider your expenses for payment.
You have 90 days from the date of Injury to submit a request for claim payment.
For claims to be eligible for coverage, you must seek medical attention within 60 days from the date of Injury.
Benefit Period:  The Policy is subject to a 365 day benefit period from date of Injury.  Medical or dental expenses that are incurred within 365 days of the date of Injury are eligible for coverage under the Policy.  Any expenses or treatments that are rendered after the 365 day benefit period will not be covered by the Policy.
Complete the OneBeacon Accident Medical Claim Form or in the instance of a law suit, the OneBeacon General Liability Claim Form.  These forms are provided to your Support Group Leader.  This form must be completed by both the claimant and the Home School Organization.
Advise your Providers/Hospitals of this insurance so they can file claims directly to OneBeacon.
Attach all Explanation of Benefits (EOB) forms that you have received from you primary insurance carrier or other healthcare plan.
Itemized bills are required.  You must submit itemized bills, balance due bills will not be processed.  See below for forms needed.

UB-04 or UB-92 or HCFA-1500 - standard forms used by Providers
Payment of bills will follow the Usual and Customary guidelines.  This means that the basis for payment of specific medical or dental claims is based on the average cost of that service by region.  The Policy does not automatically pay for services in full; it pays based on the Usual and Customary fee for that service in your area.
Dental Bills:  All dental bills must be submitted through your primary insurance's medical and dental plans first before submitting the bills to the carrier.

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