How to File an Accident Insurance Claim
If you are accidentally injured and require medical treatment, you must require and receive treatment by a licensed doctor of medicine within 90 days from the date of your accident to be eligible for policy benefits. You must complete a claim form and forward the completed form to Lawrence E. Smith and Associates, TPA., the agency that processes claims, along with copies of all ITEMIZED doctors, hospitals and any other medical bills. If you have access to other insurance, you must also file a claim with your primary insurance source and submit a copy of information received from your other primary insurance indicating the amounts that they will pay or the reasons why they are not paying any benefits to you.
Important: In order to be eligible for policy benefits, you should submit a completed accident insurance form to Lawrence E. Smith and Associates, TPA within 90 days from the date that you were injured. Claim forms and bills that are received later than one year from the date of accident will be rejected and you will not be eligible for policy benefits.
To Download and Print an Accident Insurance Claim Form, first Click on the PDF icon below.
Then Click on the tab at bottom left of your screen to open and print the claim form.