The town provides an insurance program to pay forvalid claims on an EXCESS BASIS for injuries received while participating in the West Hartford Public Schools athletic program. The insurance company will, therefore, reimburse an amount up to a maximum of $10,000 for all medical care; $1,000 for all dental treatment, services and supplies as a result of any one accident not covered by your family’s medical coverage (e.g. Blue Cross/Blue Shield, Major Medical Group Insurance, etc.) A claim form will be mailed home after any accident or injury.
Claim Form – Completion Procedure
Complete the claim in full.
Form I/Section II –Coach/Athletic Trainer
Form I/Section II –Parent/Guardian
Form II – Parent/Guardian
Form III – Attendingphysician or medical professional.
Attach all bills not paid by your family coverage and your EOB’s to the completed claim form.
Return the claim form and the unpaid bills to the athletic office for processing.
Do not send your claim formor bills to the insurance company directly. This will only delay processing of your claims.
Claims for any single occurrence of injury should be filed within five (5) days of the accident. Only in special circumstances, and with the approval of the Town of West Hartford and the insurance company, will claims be honored up to fifty-two (52) weeks from the date of the accident.
Note: Claims are not reviewed by the athletic department. All claims are sent to the town’s insurance carrier for the final decision rendered.
Claim Form – Completion Procedure
Complete the claim in full.
Form I/Section II –Coach/Athletic Trainer
Form I/Section II –Parent/Guardian
Form II – Parent/Guardian
Form III – Attendingphysician or medical professional.
Attach all bills not paid by your family coverage and your EOB’s to the completed claim form.
Return the claim form and the unpaid bills to the athletic office for processing.
Do not send your claim formor bills to the insurance company directly. This will only delay processing of your claims.
Claims for any single occurrence of injury should be filed within five (5) days of the accident. Only in special circumstances, and with the approval of the Town of West Hartford and the insurance company, will claims be honored up to fifty-two (52) weeks from the date of the accident.
Note: Claims are not reviewed by the athletic department. All claims are sent to the town’s insurance carrier for the final decision rendered.
West Hartford Public Schools
50 South Main St, West Hartford, CT 06107
T: 860-561-6600
F: 860-561-6910