Cancer and Hospital Claim Form - United Transportation Union bb - utuia 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the Policyholder's Name, Address, and Local Number at the top of the form. Ensure all information is printed clearly.
3. Indicate whether this claim is for cancer or another hospitalization by following the specific instructions provided on the form.
4. Complete the Patient Information section, including the patient's name, relationship to policyholder, birth date, and signature if applicable.
5. Detail the illness being claimed and provide dates when symptoms first appeared. If hospitalized, include hospital details and admission/discharge dates.
6. For the Attending Physician's Statement, ensure your physician fills out their section accurately, including diagnosis and any surgical procedures performed.
7. Review all entries for accuracy before submitting. Use our platform’s features to save your progress or share with others as needed.

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