Colonial Life's catastrophic accident benefit covers severe losses after an accident, such as loss of both hands or feet, sight, hearing or speech. The form states that a 365-day elimination period must be met before filing. The treating physician completes Section 2, marks each loss that applies, reports any recovery of function and sends the related medical records.
The policy owner completes Section 1, including the accident date and every physician who has treated them. The treating physician completes and signs Section 2.
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Catastrophic Accident Claim
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Section 2 lists loss of both hands or both feet, both arms or both legs, one hand and one foot, loss of use of one arm and one leg, loss of sight of both eyes, loss of hearing of both ears, and loss of the ability to speak. The physician checks every statement that describes the patient.
Only after the benefit's 365-day elimination period has been met, according to the form's first page. Section 2 then asks whether the patient has regained partial or complete use since the accident and whether further improvement is expected, so the physician reports the patient's status at least a year after the injury.
No. General accident benefits are claimed on the Accident Claim, form 67715. Form 57930 is only for the catastrophic loss benefit, and its Section 1 asks whether the claimant also holds a Colonial Life disability policy, which is claimed on its own form.