GOVERNMENT EMPLOYEES INSURANCE COMPANIES 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the current date at the top of the form. This is essential for tracking your claim.
3. Fill in your name, the date of the accident, and your claim number in the designated fields.
4. Provide your physician with the printed form so they can complete their section, including patient details like name, age, and sex.
5. Ensure your doctor describes the history of occurrence and provides a diagnosis along with any concurrent conditions.
6. Your physician should indicate whether the condition is solely due to the accident and if it affects employment capabilities.
7. After completion, ensure that your doctor signs and dates the report before submission to GEICO's Claims Department.

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