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Accidental Insurance Claims

For accidents resulting in death or other losses, follow the claim process below to ensure timely submission and payment.

Accidental Insurance Claims


The Accidental Death & Dismemberment (AD&D) coverage under the Active Plan offers financial protection to members and their beneficiaries in the event of accidental death or significant injuries caused by accidents.


How to Make an Accident Insurance Claim


1. Notify AGA Benefit Solutions

  • Contact AGA Benefit Solutions as soon as possible following the accident or death:

  • Provide details of the incident, including the date, location, and nature of the injury or death.


2. Obtain the Necessary Claim Forms

  • AGA Benefit Solutions will provide the required AD&D Claim Form.


3. Gather Supporting Documentation

  • For Accidental Death:

    • Certified death certificate.

    • Accident report or coroner’s report detailing the cause of death.

    • Proof of beneficiary designation.

  • For Dismemberment or Injury:

    • Medical documentation from a licensed healthcare provider detailing the injury.

    • Accident report (e.g., from a police or workplace report).


4. Complete and Submit the Claim Form

  • The claimant or beneficiary must:

    • Complete the form with all required details.

    • Attach all supporting documentation, such as receipts, reports, and medical evaluations.

  • Submit the completed form via:

Deadlines


  • Claims must be submitted within 15 months of the accident or death.

  • Late submissions may require a valid explanation and are subject to approval.


Claim Review Process


  1. AGA Benefit Solutions reviews the submitted claim and documentation.

  2. If additional information is needed, they will contact the claimant or beneficiary.

  3. Upon approval:

    • Benefits for accidental death are paid to the named beneficiary or estate.

    • Benefits for injuries or dismemberment are paid directly to the member.


Key Points


  • AD&D benefits are not available under the 60+ Plan.

  • Members transitioning from the Active Plan to the 60+ Plan should be aware that AD&D coverage will end upon enrollment in the 60+ Plan.

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