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11.19.02.02USBCCA_side186
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Accident Claims Information
How to file an
Accident Claim |
Obtain a Bollinger Accident Claim form from the
US Bowling Congress Coaches Association Office. You may also
click here (PDF File) to print one from this web site.
In the event of an injury requiring medical treatment you should:
1) Complete the top portion of the claim form marked "To be Completed
by Insured" and include complete copies of all itemized bills.
2) Note: this is an Excess Policy. If you are covered under any other
Insurance or Health Care Plan, you must submit your bills to your other
insurance carrier first. After your other carrier has paid their share of
the claim, you may then submit any remaining balances due under this plan.
Be sure to send copies of all invoices and the Explanation of Benefits form
detailing benefits paid from your
primary carrier with this claim form.
3) After you have completed the claim form, the bottom portion marked
"To be Completed by Policyholder/Administrator" must be filled out and
authorized by the USBCCA. Please send the claim form and all relevant
materials to:
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US Bowling Congress Coaches
Association
5301 South 76th St.
Greendale, WI 53129
800-514-BOWL
The USBCCA will
then forward the claim to Bollinger for processing and payment.
You are required to have Adobe Acrobat
Reader to view the following claim form. If you do not have this
required plug-in, you may click here the icon below to download it
now.
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