Detail injury 2026

1. Click ‘Get Form’ to open the Detail of Injury Questionnaire in the editor.
2. Begin by entering your Member Name and Group Name in the designated fields at the top of the form.
3. Fill in your Student ID, followed by the Date of Injury. Ensure accuracy for timely processing.
4. Specify the Body Part affected by the injury, including whether it is on the left or right side.
5. Indicate where the injury occurred (e.g., home, work) and provide a detailed explanation of how it happened.
6. Answer whether the injury is work-related, a result of a motor vehicle accident, or sports-related by checking 'Yes' or 'No' as applicable.
7. If applicable, attach any required documents such as an Auto PIP Breakdown of Payments for motor vehicle accidents.
8. Finally, sign and date the form at the bottom before submitting it via mail, fax, or email as instructed.

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