Insurance Claims
To submit an insurance claim
- Download and print form below.
- Gather all paid medical bills (if you have any at this point)
- Fill out the form (as soon as possible once an incident occurs)
- Submit claim form and bills (you can submit bills later as well)
- Email to Mark Menconi at markmenconi@sbcglobal.net
- Mark will submit the claim form to our supplemental medical coverage carrier.
- You can submit bills as you go along in the process directly to the insurance company
- You can email Mark directly if have any questions regarding the form.