Student Accident Claim Packet - Barnegat Township School 2026

1. Click ‘Get Form’ to open the Student Accident Claim Packet in our editor.
2. Begin with Part 1A - Policyholder. Fill in the College/University name, policy number, student’s name, date of birth, and details about the injury including the date and type of sport or activity.
3. In Part 1B, provide the injured person's information such as their Social Security Number, home address, phone number, and email. Ensure to indicate if they have other insurance coverage.
4. Complete the Parent/Guardian Information section by entering names, contact details, and employment status for both parents or guardians.
5. Review the Medical Information Authorization & Assignment of Benefits section carefully. Sign and date where indicated to authorize information sharing with BMI Benefits.
6. Finally, ensure all sections are completed accurately before submitting your claim within 90 days from the date of accident.

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