"How do I submit a claim?"
Should an accident requiring a claim occur, please follow these steps to ensure speedy and accurate payment.
This program provides secondary coverage for school-time accident claims. First, submit the claim to the parent or guardian’s primary insurance carrier (please be aware of primary networks). Then, submit a Claim Form to Commercial Travelers according to the instructions below. In the event that a child does not have primary coverage, claim submissions should be sent directly to Commercial Travelers Mutual Insurance Company.
Download an ISM Student Accident Insurance Claim Form. They are supplied to ISM by Commercial Travelers Mutual Insurance Company. All claims must be submitted on the proper form.
Part A: School Instructions
- A School Report must be completed by a school official. Be sure to provide all necessary information. Don't forget to include your school's current Policy Number.
- Once complete, give the form to the student’s parent or guardian.
Part B: Parent Instructions
- A Statement of Parent or Guardian must be completed in full by the student's legal guardian. Please do not leave any blank spaces
- If you have purchased the Parental Voluntary Extension Program, Commercial Travelers coverage will act as primary Accident or Accident and Sickness (if applicable) Insurance. Please refer to your brochure for details.
- Sign and date the form.
- Contact all physicians, hospitals, and other health care providers who have treated or will be treating your child and provide them with the information on your school’s Student Accident Insurance. You may request that providers bill Commercial Travelers directly. In the event that a provider will not bill Commercial Travelers directly, request copies of all itemized bills and forward them to Commercial Travelers’ address below. (Please make sure the student’s name and policy number are clear on all bills.)
- Subsequent bills for follow-up care can be submitted to Commercial Travelers on their own without completing additional claim forms. Do not send Collection Notices, Balance Due Statements, or Receipts. All bills must have the name of the provider, date of service, total charges, diagnosis codes, procedure codes, and the provider’s Federal Income Tax ID Number.
- If you have made any payments directly to a provider, please be sure to include a paid receipt along with the itemized bill (see above) stating whom you have paid, the date of service, and how much was paid. Be sure to indicate whom Commercial Travelers should reimburse and supply a mailing address.
- Make copies of all forms for your records.
Mail claim forms and bills directly to:
IS/IT Claims Administration Center
Commercial Travelers Mutual Insurance Company
70 Genesse Street
Utica, NY 13502
Contact ISM's Student Accident and Sickness Administrator, Lisa Irwin by email, or call 302-656-4944.