Get Texas Clm 2 Form Access Texas Clm 2 Editor

Get Texas Clm 2 Form

The Texas Clm 2 form is a vital document used to report student accidents and initiate claims for medical expenses. It serves as a means for parents and guardians to communicate injury details and insurance information to the appropriate authorities. Understanding how to accurately complete this form can significantly aid in ensuring that necessary medical costs are covered.

Access Texas Clm 2 Editor
Content Navigation

The Texas CLM 2 form is an essential document for parents and guardians navigating the claims process for student injuries that occur at school. This form is specifically designed to facilitate the reporting of accidents, ensuring that all necessary information is collected efficiently. It consists of two main sections: the first part requires completion by a school official, detailing the circumstances of the injury, including the time, place, and nature of the incident. If the injury occurred during a school-related activity, the school must provide their input. The second section is intended for parents or guardians, who must provide personal information about the injured student, insurance coverage details, and an authorization for the release of medical information. Understanding how to properly fill out and submit the Texas CLM 2 form is crucial, as it must be submitted within 90 days of the injury. This form serves not only as a means to initiate a claim with Fidelity Security Life Insurance Company but also as a reminder that schools typically do not cover medical expenses directly, making it vital for families to engage with their own insurance providers as well. With clear instructions and guidance, this form helps streamline the claims process, ensuring that students receive the necessary care and support following an accident.

Dos and Don'ts

Things to Do When Filling Out the Texas Clm 2 Form:

  • Complete Section 1 by a school official for school-related accidents.
  • Ensure Section 2 is filled out by the parent or guardian.
  • Submit the claim form within 90 days of the injury.
  • Keep a copy of the claim form for personal records.
  • Provide itemized bills, not monthly statements, with the claim submission.
  • File a claim with your primary insurance before submitting to the supplemental policy.
  • Contact the school trainer or administrator for assistance with school-related accidents.
  • Use the correct address for submission: Fidelity Security Life Insurance Company, c/o Universal Fidelity Life Insurance Company, P.O. Box 304, Duncan, OK 73534-0304.

Things Not to Do When Filling Out the Texas Clm 2 Form:

  • Do not submit the claim form after 90 days from the date of injury.
  • Do not rely on the medical provider to submit the claim form on your behalf.
  • Do not submit monthly statements instead of itemized bills.
  • Do not skip filling out any required sections of the form.
  • Do not assume the school will cover medical expenses without filing a claim.
  • Do not forget to include copies of Explanation of Benefits (EOB) from your primary insurance.
  • Do not leave out any necessary information regarding the student's insurance coverage.
  • Do not submit the claim form without the required signatures.

Get Answers on Texas Clm 2

What is the Texas CLM 2 form?

The Texas CLM 2 form is a Student Accident Claim Form used to report injuries sustained by students during school-related activities. It is essential for parents or guardians to complete this form to seek reimbursement for medical expenses related to the injury. The form requires information from both a school official and the parent or guardian.

Who needs to fill out the form?

Section 1 of the form must be completed by a school official for all school-related accidents. If 24-Hour coverage was purchased and the accident is not school-related, the parent or guardian should fill out this section. Section 2 must always be filled out by the parent or guardian, providing personal and insurance details of the injured student.

How do I submit the Texas CLM 2 form?

To submit the form, follow these steps:

  1. Complete the claim form, ensuring all necessary sections are filled out.
  2. Send the form to the Claims Office at Fidelity Security Life Insurance Company, P.O. Box 304, Duncan, OK 73534-0304, or email it to SAclaims@uflic.com.
  3. Ensure the claim form is submitted within 90 days from the date of injury.

It is crucial to keep a copy of the claim form for your records and provide a copy to the medical provider or facility.

What should I include with the claim form?

Along with the completed claim form, you should include:

  • Copies of itemized bills from medical providers. These should be original bills, not monthly statements.
  • Explanation of Benefits (EOB) from your primary insurance, if applicable.

Itemized bills often come in UB92 or HCFA1500 formats, detailing procedure codes, diagnosis codes, and the provider's information.

What if my child has no other insurance?

If your child does not have any other insurance, the school’s policy may serve as the primary coverage for medical expenses. However, it is important to note that this is a limited benefit policy and may not cover all medical costs. Parents should be prepared to cover any expenses not included in the policy.

How to Use Texas Clm 2

Filling out the Texas Clm 2 form is an important step in ensuring that your child's medical expenses are addressed following an accident. By following these steps carefully, you can submit your claim efficiently and effectively. Once completed, the form should be sent to the appropriate claims office for processing.

  1. Gather necessary information, including your child's details, the accident specifics, and insurance information.
  2. Complete Section 1, which must be filled out by a school official for school-related accidents. If 24-Hour coverage was purchased and the accident is not school-related, a parent or guardian can complete this section.
  3. Fill out Section 2, which is designated for the parent or guardian. Provide all requested details, including the child's name, date of birth, and insurance information.
  4. Sign and date the form in the designated areas to validate the information provided.
  5. Make a copy of the completed form for your records and for your provider or facility. Do not depend on them to submit the claim.
  6. Submit the claim form to Fidelity Security Life Insurance Company at the address provided: P.O. Box 304, Duncan, OK 73534-0304. Alternatively, you can send it electronically to SAclaims@uflic.com.
  7. Submit itemized bills, which are original bills received from medical providers, not monthly statements. Ensure these bills include necessary codes and provider information.
  8. File a claim with your primary insurance first. Submit copies of all bills to them before proceeding with the Texas Kids First claim.
  9. After receiving payment or Explanation of Benefits (EOB) from your primary insurance, send a copy of the claim form along with the itemized bills and EOBs to the address mentioned above.

Common mistakes

When filling out the Texas Clm 2 form, many people inadvertently make mistakes that can delay or complicate the claims process. Understanding these common pitfalls can help ensure a smoother experience. Here are five mistakes to watch out for.

One frequent error occurs in Section 1, where the school official must provide details about the injury. Sometimes, the school official may forget to include critical information, such as the time of the injury or the specific activity the student was participating in when the accident occurred. This omission can lead to confusion and may require additional follow-up, delaying the claim.

Another common mistake happens in Section 2, where parents or guardians must provide their information. Often, they neglect to indicate whether the student is covered by any other insurance plan. This detail is essential, as it determines how the claim will be processed. If this section is left incomplete, it can lead to unnecessary complications later on.

Additionally, many parents fail to submit the claim form within the required 90 days from the date of injury. This deadline is crucial, and missing it can result in the denial of the claim. To avoid this mistake, it’s important to keep track of the submission timeline and ensure that all necessary documents are sent in promptly.

Another oversight is the submission of itemized bills. Parents sometimes send monthly statements instead of the required original itemized bills. These bills must include specific details such as procedure codes and the provider's information. Not following this guideline can lead to delays or denials in processing the claim.

Finally, many individuals do not keep copies of the submitted claim form and supporting documents. This practice is crucial, as having a record of what was sent can be invaluable if questions arise later. Keeping a copy ensures that you have all the necessary information at your fingertips, making it easier to address any issues that may come up during the claims process.

More PDF Forms