Student Accident Claims Procedures

  • ***REMINDER***
    You must file a claim with your primary family insurance first.
    Claim forms must be filed within 90 days of an accident to be eligible for coverage. 
    Neither the school nor SDMC can mail claim forms to School Insurance of Florida on your behalf. 
    Please do not call the school to ask questions about coverage or the status of a claim payment.

    Parents, Students and School Administrators - How to File a Claim

    Claim forms need to filed within 90 days of an accident to be eligible for coverage. Obtain a claim reporting form from your school or download one from this website. Complete the claim form and mail to School Insurance of Florida, P. O. Box 784268, Winter Garden, FL 34778-4268.

    Important Claim Filing Information
    1) This coverage is secondary, 'EXCESS' insurance, and will not pay for 100% of billed charges. Download Summary of Insurance Benefits for a listing of covered benefits.

    You must file a claim with your primary family insurance first. If your son or daughter has an accident at school and you have purchased the student insurance program, please obtain a claim form from the school principal's office or the athletic office where your son or daughter attends school.

    2) Part B of the claim form must be filled out by a supervising school official if the injury happened at school. The Parent is required to complete Part A and mail to School Insurance of Florida's claim office.

    Please follow the instructions printed on the claim form. 
    Claim Form - English
    Formulario de Reclamo - Español

    3) You will need to attach copies of all itemized medical bills. If you have other primary insurance, you will need to file a claim with your primary insurance carrier and include a copy of the letter or statement from your primary insurance indicating the payments provided by them or their reasons for refusal to pay benefits to you.  A hospital or doctor's office should be able to provide an itemized medical bill for you.

    4) It is the Parent/Legal Guardian’s responsibility to file a claim within 90 days from the date of accident. The school is not responsible for filing claims. However, the school will provide you with a claim form or you can download one from this website or contact School Insurance of Florida to obtain a claim form. Please forward the completed claim form to School Insurance of Florida no later than 90 days after the date of accident to be eligible to receive any available policy benefits. You must file a claim with any other primary insurance, even if you have a deductible. This includes HSA, HMO or PPO plans.  Please do not mail completed claim form to the SDMC. 

    WE CANNOT ACCEPT CLAIMS SUBMITTED ONLINE because a school official’s signature and the parent/legal guardian signature are needed on the form. You only need to submit ONE completed claim form for each accident. You do not have to send another claim form if you are submitting additional bills that come in later. PLEASE DO NOT CALL THE SCHOOL ABOUT THE STATUS OF A CLAIM PAYMENT OR TO ASK QUESTIONS ABOUT COVERAGE. Contact SCHOOL INSURANCE OF FLORIDA if you need answers to claim or coverage issues. The school does not keep records regarding claims. All claims are processed by School Insurance of Florida's claim office. When contacting School Insurance of Florida's office about a claim, please state the full name of your injured son or daughter and the SCHOOL DISTRICT where he or she attends school. We need the school name to reference the claim information for you. Generally, valid claims are processed within 7 working days after receipt of completed claim information.

    Parents, Students and School Administrators - Where to Seek Medical Treatment
    If a student has primary insurance, they should stay in that primary insurance network even if they have a deductible. They must file a claim with any primary insurance coverage first to be eligible for the student accident insurance even if they have a deductible. If there is no primary insurance coverage, students may seek medical treatment from any licensed hospital or licensed physician and be eligible to receive the stated school policy benefits that are outlined in the enrollment application.  It is the parent or student's responsibility to ask the Doctor or provider of service what out of pocket expense they may be held accountable for paying.

    Please refer to the summary of insurance for a summary listing of policy benefits, limitations and exclusions. The Insurance Company cannot regulate how much doctors or other providers of service charge. Doctors and Hospitals are allowed to establish and charge their own fee levels. Doctors and Hospitals may charge more than what the School Insurance of Florida accident insurance policy pays. The insurance benefits will be paid based upon the stated policy provisions. Please retain a Summary of Insurance for your records.

    The primary contact in Risk Management for Student and Liability Insurance is Christine Coates at (941) 708-8770 x41058 or Email.

    FLORIDA LAW STATES: Any person who knowingly and with intent to injure, defraud or deceive any insurance company, files a statement of claim or an enrollment form containing any false or incomplete, or misleading information is guilty of a felony of the third degree.