Offline Claim Form

Claim Procedure

Authorization form

Claimant Appeal Request Form

Lost Checked Luggage

Accident Questionnaire

Trip Interruption

Online Claim Form

ClientZone

Must submit proof of claim with in 60 days from date of service 

service@worldtrips.com

Must submit Appeal to
appeals@worldtrips.com

WorldTrips

Claims Department

Box. No. 2005

Farmington Hills, MI 48333-2005
U.S.A.

800-605-2282

Or

317-262-2132

Sample letter for Appeal

Medical Claim Form/Proof of Loss Form

Authorization Form to Disclose Protected Health Information

Must send claim form and payment receipts with in 90 days from date of service

claims@sevencorners.com

Seven Corners

Attention: Claims Department

303 Congressional Boulevard

Carmel, IN 46032

800-335-0611

Or

317-575-2656

Claim Form

General Accident Questionnaire

Privacy and Confidentiality Release Form

Must submit proof of loss

customercare@imglobal.com

International Medical Group, Inc.

Attention: Claims Department

PO Box 9162

Farmington Hills, MI 48333

800-628-4664

or

317-655-4500

Claimant's Statement

Non-U.S. Claim Form

Accident Questionnaire

Dental Claimant's Statement

Must submit proof of claim with in 60 days from date of service 

service@hccmis.com

HCC Medical Insurance Services, LLC

Attention: Claims Department

P.O Box 2005

Farminton Hills, MI 48333-2005

800-605-2282

Or

317-262-2132

Claimant's Statement

Non-U.S. Claim Form

Accident Questionnaire

Dental Claimant's Statement

Claimant's Statement

Non-U.S. Claim Form

Accident Questionnaire

Dental Claimant's Statement

Claimant's Statement

Non-U.S. Claim Form

Accident Questionnaire

Dental Claimant's Statement

Appeal Form (for GBG Underwriter Plans Only)

Claim Form

Authorization Form to Disclose Protected Health Information

Trip Delay Claim Form

Trip Interruption Claim Form

Baggage Claim Form

GBG Administrative Services Inc.

Co-ordinated Benefit Plans,

LLC on Behalf of Crum and Forster SPC,

PO Box 2069 Fairhope AL 36533

Phone No #866-669-9004 or 866-696-0409

Claim Form

Death Claim Form

Dismemberment Claim Form

Baggage Loss, Theft or Damage

Authorization Form to Disclose Protected Health Information

Must submit proof of loss with in 60 days from date of service

claims@globalunderwriters.com

Global Claims Administration

3195 Linwood Road, Suite 201

Cincinnati, OH 45208

US & Canada

800-513-2981

Outside US & Canada

1-513-533-1330

Claim Form

Authorization For Reimbursement Form

Accident Questionnaire

Trip Delay

Must submit proof of loss

service@azimuthrisk.com

Azimuth Risk Solutions

Attention: Claims Department

P.O Box 627

Indianapolis, IN 46206