Filing a K-12 Accident Claim

1. At the top of the form, please check the box for the Underwriting Company, either Commercial Travelers or Fidelity Security Life. The name of the company is available from your school nurse if you are not sure which one applies.
   
   
2. Part A (the first page) must be completed and signed by a school official. Part B (second page) must be completed and signed by the insured student's parent or guardian.
   
   
3. If you have other insurance, all bills must first be submitted to the other insurance company. Then, attach all itemized medical bills you have received for this accident, and all Explanation of Benefits (EOB) forms from your other carrier and mail or fax them to us. Bills received after filing the claim can be sent to us later. Please indicate the school name on any such bills.
   
   
4. Save copies of all submitted materials for your records.
   
   
5. Mail these two completed and signed pages, (along with the EOB's and bills) within 90 days after the first treatment, to:

   School Claims Department

   Commercial Travelers Mutual Insurance Company

   70 Genesee Street

   Utica, NY 13502

    

6. For even faster service, please fax the forms and bills to: 315/797-0195.