bollinger and lax

Claims Information :: How to File a Claim

Submitting a claim has never been easier!


Our eClaims application walks you through the process step by step.

eClaims saves you time by asking only for the information your claim requires.

    

Claims Status

To check the status of an Accident Claim, please complete our online form.

How It Works


1. Complete all the information required on the claim form
      * A completed Accident claim form must be submitted to Bollinger within 1 year of the injury date.
2. Once complete, print out the pre-filled claim form
3. Have the coach or team manager sign the claim form
4. Mail the claim form to Bollinger for processing
    

Blank Claim Form

If you would like a blank claim form, please select your accident date below and then press “Print Blank Claim Form”.

*Accident Date




Instructions:

  1. Complete the claim form
    • A completed Accident claim form must be submitted to Bollinger within 1 year of the injury date.
  2. Have it signed by the coach
  3. Mail it to Bollinger for processing

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