Obtain a Bollinger Accident Claim form from the State Association office, or your Club or League Office. You may also click here to print one from this web site. In the event of an injury requiring medical treatment you should:

1) Complete the top portion of the claim form marked "To be Completed by Insured" and
include complete copies of all itemized bills.

2) Note: this is an Excess Policy. If you are covered under any other Insurance or Health Care Plan, you must submit your bills to your other insurance carrier first. After your other carrier has paid their share of the claim, you may then submit any remaining balances due under this plan. Be sure to send copies of all invoices and the Explanation of Benefits form detailing benefits paid from your primary carrier with this claim form.

3) After you have completed the claim form, the bottom portion marked "To be Completed by Policyholder/Administrator" must be filled out and authorized by the State Association. Please
send the claim form and all relevant materials to:

The State Association will then forward the claim to Bollinger for processing and payment.
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