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SCHOOL ACCIDENT INSURANCE POLICY 2004-2005
Our school has purchased School Time Accident
Coverage to protect all students against accidental injury or
death occurring during the hours and days when school is in
session, and while attending or participating in school sponsored
and supervised activities. Coverage is underwritten by Mutual of
Omaha Insurance Company and administered by Special markets
Insurance Consultants Inc.
The eligible expenses are payable 100% of
Usual and Customary Charges up to a maximum benefit of $1.000,
000. Benefits are payable on a full excess basis
which means benefits are only paid for expenses which are not
recoverable from any other insurance policy, service contract or
worker’s compensation. Expenses incurred within ONE
year after the date the accident are covered. The initial
treatment for an injury must be incurred within 120 days after the
accident date.
CLAIM FILING INSTRUCTIONS:
ü
Notify the school of the accident and secure a claim
form.
ü
Answer all questions on the form in detail; be sure
to sign the form.
ü
Attach all bills to the completed form and mail it
to the following address within 90 days of the accident (any bills
not filed with the claim form should be sent to the address below
and should include the student’s name, school district and the
date of the accident):
Mutual of Omaha
Special Risk Services
P.O.Box 31156
Omaha, NE 68131
Claim Inquiries: 1800-524-2324
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