Filing a Special Risk Claim

1. Have an Official of the Organization complete, date and sign Part. A
   
   
2. Part A (the first page) must be completed and signed by an Organization Official. Part B (second page) must be completed and signed by the injured Person - or if the injured person is under 18 or otherwise dependant by his/her 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 Organization 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:

   Special Risks 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.