Submit the completed claim form along with your eligible medical expenses to receive reimbursement.
Fill out the top section and give details about your accident or illness. Your supervisor needs to fill out the middle section, and your doctor will need to fill out the bottom section.
You’ll need to write in the details of your accident, and have your supervisor give details about your time off work. Then your doctor will need to write in your diagnosis and the dates you will be off work. You can fax it to the claims department at the number listed on the claim form, or call the claims department and they will help you file it.