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Combined insurance claim forms printable 2026

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The document provides detailed instructions for filing accident and health claims with the Combined Insurance Company of America. It outlines the necessary information and forms required for different types of claims, including medical expenses, disability, and hospital confinement. The document emphasizes the importance of timely submission and accurate completion of claim forms to avoid delays in processing. Additionally, it includes fraud notification warnings specific to various states, highlighting the legal consequences of submitting false information.

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Click ‘Get Form’ to open the combined insurance claim form in the editor.
Begin by completing the claimant information on the first page. Ensure you provide your full name, current mailing address, and policy numbers for efficient processing.
If applicable, fill in details regarding your symptoms and diagnosis for sickness claims or provide a detailed description of the accident for injury claims.
For hospitalization claims, include the hospital's name, address, admission and discharge dates, along with an itemized bill.
Sign and date the Authorization to Release Information at the bottom of the first page to prevent delays.
Have your doctor complete the Attending Physician’s Statement on the second page and ensure your employer fills out their section if claiming disability.
After completing both pages, print them out. Keep a copy for your records before mailing it to Combined Insurance Company at the provided address.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How do I file a claim with combined insurance?

To file Combined Insurance claims, print the claim form instructions, then simply click and print out the appropriate form from the available list below. Complete the form; specific sections must be completed by your employer and doctor, and mail or fax it to the appropriate address or fax number.

How long do I have to file a claim with combined insurance?

How long from the date of the service do I have to file a claim? In order to take care of your claim as soon as possible, we ask that you give us written notice of a claim within 30 days after a covered loss starts, or as soon as is reasonably possible.

What are the steps to making an insurance claim?

Six Steps in Making an Insurance Claim Step One: Contact Your Agent Immediately. Step Two: Carefully Document Your Losses. Step Three: Protect Your Property from Further Damage or Theft. Step Four: Working with Adjustor. Step Five: Settling Your Claim. Step Six: Repairing Your Home.

How do I make a claim on insurance?

If you need to make a claim contact your insurer as soon as possible and ask them to send you a claim form. They may be able to email this to you to speed things up. Complete the claim form carefully and keep a copy for yourself.

What are the two types of claim forms?

The two most common claim forms are the CMS-1500 and the UB-04. These two forms look and operate similarly, but they are not interchangeable. The UB-04 is based on the CMS-1500, but is actually a variation on itits also known as the CMS-1450 form.