Nurse's Office
Accident Insurance
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 |
