A Claim Form is a document used to formally submit a claim to an insurance company, the government, or to a business organization. When a claim is submitted and approved, certain benefits and compensation are then provided to the individual who filed it. These compensations and benefits are based on the company or organization’s guidelines and the qualifications of the individual.

There are various types of Claim Forms for various purposes. One example is Medical Claim Forms used to file claims for medical expenses. Just as there are various purposes for Claim Forms, there are also various formats one can use to draft such a form. You may see our samples below.

Project Claim Form Sample

Details
File Format
  • PDF

Size: 376 KB

Download

Insurance Claim Form Sample

Details
File Format
  • PDF

Size: 17 KB

Download

Expenses Claim Form Sample

Details
File Format
  • PDF

Size: 157 KB

Download

Sample Quit Claim Form in PDF

Details
File Format
  • PDF

Size: 142 KB

Download

Warranty Claim Form Sample

Details
File Format
  • PDF

Size: 194 KB

Download

Guidelines in Writing a Claim Form

  • At the beginning of the Claim Form, the name and details of the company where the Claim Form will be submitted to should be stated, along with a title that would indicate what type of claim will be filed.
  • Secondly, there should be a section for the individual making the claim to input his personal details, such as his name, address, and contact details, and any information relating to the qualification of the individual to make a claim. Such information could be employment details or the individual’s insurance policy number that will cover the circumstance the individual is making a claim for.
  • The third section should then be a space for the individual to write details of the circumstance that led to him filing a claim. For example, for Disability Claim Forms, there should be details about the incident that led to the disability and the medical information needed from the doctor to certify that he has been examined and certain limitations have been noted on the person’s mobility. This information is crucial in the decision-making process for the approval of the claim.
  • Lastly, there should be a section for the individual to indicate the dollar amount that will be covered.

Sample Medicare Claim Form

Details
File Format
  • PDF

Size: 31 KB

Download

Accident Claim Form Sample

Details
File Format
  • PDF

Size: 970 KB

Download

Dental Claim Form Example

Details
File Format
  • PDF

Size: 511 KB

Download

Employee Claim Form Sample

Details
File Format
  • PDF

Size: 595 KB

Download

Types of Claim Forms

  • Health Care Claim Forms – This is used by health insurance providers and employers to provide reimbursement for a range of medical or healthcare services covered by the individual or employee’s health insurance policy. The individual’s medical care facility will forward or submit this Claim Form to the health insurance provider for them to process and determine what costs are covered, and any remaining amount not included in the policy will then be forwarded to the medical care facility so that the individual can settle that amount directly with them.
  • Warranty Claim Forms – This is used by retailers or wholesalers to allow their customers to submit claims whenever their purchased item/s or equipment get damaged or defective within the warranty period. This is so that the item or equipment can be repaired and if necessary, the defective parts can be replaced.
  • Accident Claim Forms – This is used by insurance companies for their insured members to file a claim in the event of an accident. The accident can either be a motor vehicle accident, a personal accident, or an accident occurring in the workplace.
  • Expenses Claim Forms – This is used by organizations and companies for use by their employees and visitors if they want to make claims for expenses incurred for business purposes.

Related Posts