A Claim Form is a document that is used to file claims from an insurance company, business organization, or the government. Examples of such claims are Duty Claims, Health Care Claims, and Accident Claims, among others. A claim is compensation provided to an employee or student that is in line with the terms and conditions of a certain insurance policy. There are a lot of different Claim Forms that can be used for different types of scenarios. You may see our downloadable samples below that you can use to draft your own. After your perusal, you will find that they are easy to understand.

Healthcare Claim Forms

United Healthcare Claim Form

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Size: 4 KB

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Health Insurance Claim Form

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  • PDF

Size: 215 KB

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Extended Health Care Claim Form

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  • PDF

Size: 334 KB

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Duty Claim Forms

Employer Duty Claim Form

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  • PDF

Size: 213 KB

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Private Duty Nurse Claim Form

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  • PDF

Size: 109 KB

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On Duty Assault Benefit Claim Form

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  • PDF

Size: 53 KB

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Extra Duty Hours Claim Form

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  • PDF

Size: 132 KB

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School Claim Forms

School Milk Subsidy Claim Form

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  • PDF

Size: 62 KB

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Schools Personal Accident Claim Form

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  • PDF

Size: 223 KB

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School Insurance Claim Form

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  • PDF

Size: 263 KB

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Medical Claim Forms

Medical Claim Form in PDF

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  • PDF

Size: 339 KB

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Major Medical Claim Form

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  • PDF

Size: 577 KB

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Medical Treatment Benefit Claim Form

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  • PDF

Size: 81 KB

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Medical Expense Claim Form

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  • PDF

Size: 41 KB

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Tips in Writing a Claim Form

  • At the beginning of the Claim Form, indicate your name, address, and your contact details in case the insurer needs to contact you for further details.
  • After that, state that you are making a claim and what kind of claim you are making. You can also state the policy number that cover your circumstance so that the insurer will be informed right away.
  • You would also be required to provide specific details about the incident that happened and which led you to file a claim. If necessary, your Claim Form should also come with supporting documents to substantiate your claim. For example, if you are filing a Travel Expense Claim, you are to provide proof of the expenses, such as receipts of meals and accommodation, and your airline itineraries. This is important so that your claim will be approved and so that the process will be more seamless.
  • Include the dollar amount that will be covered by your insurer or employer.

Healthcare Claim Forms

This is a Claim Form that is used to get reimbursement for a range of medical or healthcare services covered by your health insurance policy. What happens is that your healthcare provider (hospital, clinic, or any medical facility) will submit the Healthcare Claim Form to your health insurer. Any expense or cost that is covered under your health insurance policy will be reimbursed by your health insurer, and any remaining cost will then be covered by you. Once this has been processed by your health insurer, a bill or invoice will be sent to you by your health care provider so that you can settle the remaining balance of your medical bills with them.

Who Can Use Healthcare Claim Forms?

Any medical facility such as hospitals and clinics, and health care practitioners can use Healthcare Claim Forms. This is an easier way for health care providers to communicate with health insurers regarding the reimbursements of medical expenses of insured individuals. Because Healthcare Claim Forms make claim filing easier and more formal, the whole process can be easier and more seamless as well. Healthcare Claim Forms are also important for safekeeping and recording purposes in case they would need to look up previous claims for future reference. In line with this, you may also see our Health Insurance Forms.

Duty Claim Forms

These are Claim Forms used by employees to obtain compensation for missed days of work due to a medical emergency or whatever covered incident may have happened. This is submitted to their employers for filing and approval. Here are a few examples of Duty Claim Forms:

  • Employer Duty Claim Form – Whenever an employee misses work because he is called by the government for jury duty, he is to file this form so that he can be compensated for missed days. Since jury duty is mandated by the government, it is only right that the employee will be compensated. However, it is not mandated by the federal government that an employer should provide compensation to employees for missed work in such cases, so it is good to check with your employer first regarding this.
  • On Duty Assault Benefit Claim Form – Law enforcement officers are always exposed to danger because they deal with criminals and lawbreakers. Due to this, it is not uncommon for them to be assaulted on the job. Such assaults that could occur are when an officer gets stabbed, shot, disfigured, burnt, or scarred. Whenever a law enforcement officer becomes unfit to work for three consecutive days or more due to the assault, it is mandatory that they file an On Duty Assault Benefit Claim Form so that they will be compensated for the missed days of work.
  • Extra Duty Hours Claim Form – There are instances when an employee has to fill in for or cover the shift of another employee due to an absence. Such absences may be caused by a resignation or a sick leave, among others. For filing and approval purposes, it is important that the reason for the absence of the other employee, and the number of hours and days worked are stated, and the employee will be covering the absent employee’s shift should file an Extra Duty Hours Claim Form so that he will be compensated accordingly. You may also see our Employment Forms for your other needs.

Travel Claim Forms

Travel Expenses Claim Form

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  • PDF

Size: 368 KB

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Travel Insurance Claim Form

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  • PDF

Size: 59 KB

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Travel Allowance Claim Form

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  • PDF

Size: 74 KB

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Disability Claim Forms

Disability Claim Application Form

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  • PDF

Size: 97 KB

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Group Disability Claim Form

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  • PDF

Size: 146 KB

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Short Term Disability Claim Form

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  • PDF

Size: 2 MB

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Disability Insurance Claim Form

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  • PDF

Size: 736 KB

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Income Claim Forms

Income Support Claim Form

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  • PDF

Size: 336 KB

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Hospital Income Claim Form

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  • PDF

Size: 58 KB

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Retail Income Protection Claim Form

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  • PDF

Size: 148 KB

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Medicare Claim Forms

Medicare Prescription Drug Claim Form

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  • PDF

Size: 290 KB

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Medicare Two-Way Claim Form

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  • PDF

Size: 135 KB

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Medicare Prescription Claim Form

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  • PDF

Size: 76 KB

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Travel Claim Forms

Travel Claim Forms are used for travel purposes. There are a lot of Travel Claim Forms that you can use, such as:

  • Travel Expenses Claim Forms – This is submitted to an employer by his employee to get reimbursement for travel expenses. Employees sometimes have to go to business trips to meet potential clients or to branch out their business, and expenses incurred during such business trips have to be reimbursed by the employer if it came out of the employee’s pocket.
  • Travel Insurance Claim Forms – There are a lot of travel insurance types available in the market today. With the present dangers we are exposed to in our daily dealings, we have insurance for just about anything. Examples of travel insurance are accident insurance, medical insurance, baggage and personal belongings insurance, and life insurance, among others. Travel insurance is not just for frequent flyers, but it can be utilized by occasional flyers as well. It is only important to choose a travel insurance that does not overlap with the ones you already have. For filing of such insurance claims, Travel Insurance Claim Forms are utilized, but you may also see our other Travel Forms for more samples.

Guidelines in Filling Out Travel Expenses Claim Forms

  • Keep detailed receipts for every purchase you made. A credit card billing statement is usually not enough, so be ready with your receipts to substantiate your expenses claim. If you lost your original receipt, you can submit a copy instead, but the reason why a copy is being submitted has to be explained.
  • Make sure that your Travel Expenses Claim Form is properly and completely filled out, and that all information is accurate and true. List all the details of your expenses, which would include the date, the type of expense, and the actual amount. Such expenses would include accommodation, mileage, transportation, and meals and entertainment. Meal expenses should be listed daily and not for every meal that you have.
  • List expenses in a daily manner, with the exception of airline tickets and mileage records. For mileage tracker, you may see our Sample Mileage Tracker as a basis for your own.
  • It is most important not to request for reimbursement for expenses that are personal and not business-related. You would want to uphold your credibility and the trust that you have established in your relationship with your employer.

With these guidelines in mind, it is also important to note that Travel Expense Claim Forms are not only utilized in the business setting, but in the academic setting as well. There are instances when a student, especially a graduate student, has to travel to attend seminars and conduct research. In these instances, a Travel Expense Claim Form comes in handy.

Accident Claim Forms

Accident Claim Forms are used to file a claim with your insurer in the event of an accident. This can either be a motor accident insurance or a personal insurance.

  • Motor Accident Insurance Claim Form – This is submitted by the insured person to his insurer so that the damages caused by a motor or vehicular accident will be compensated by his insurer. Some insurers pay cash to pay for the damages incurred and would need your banking details to deposit the money in.
  • Personal Accident Insurance Claim Form – This is used for other types of accidents aside from a motor accident. If the person is temporarily debilitated and cannot work due to the accident, he can file a claim to cover for his daily expenses while he is out at work. If he becomes permanently disabled, he can then file a disability claim.

Claim Request Forms

Claim Resubmission Request Form

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  • PDF

Size: 84 KB

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Difference Claim Request Form

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  • PDF

Size: 149 KB

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Freight Claim Request Form

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  • PDF

Size: 275 KB

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Claim Appeal Request Form

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  • PDF

Size: 103 KB

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Account Claim Forms

Spending Account Claim Form

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  • PDF

Size: 499 KB

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Health Spending Account Claim Form

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  • PDF

Size: 259 KB

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Flexible Spending Account Claim Form

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  • PDF

Size: 64 KB

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Reimbursement Account Claim Form

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  • PDF

Size: 256 KB

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Accident Claim Forms

Motor Accident Insurance Claim Form

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  • PDF

Size: 1 MB

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Personal Accident Claim Form

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  • PDF

Size: 43 KB

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Personal Accident Insurance Claim Form

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  • PDF

Size: 133 KB

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Accidental Injury Claim Form

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  • PDF

Size: 40 KB

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Custom Claim

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  • DOC

Size: 73 KB

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52. Expense Claim Form

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  • XLS

Size: 701 KB

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Disability Claim Forms

Disability Claim Forms are documents used by disabled people, whether the disability is short-term or long-term, to file a claim to respective government departments or to an employer if the accident or disaster that led to the disability occurred in the workplace. This is so that the claimant can receive financial assistance for his daily expenses, if he is unable to work anymore, or so that he will be compensated for his missed work if he is only temporarily disabled. Here are a few examples of Disability Claim Forms:

  • Group Disability Claim Form – When you are employed full-time and if your employer offers group benefits, then there is a good chance that you have Group Disability Insurance. This type of insurance coverage covers even those accidents that are non-work related and are used to provide financial aid to employees so that they can recover from their injury and disability and return to work. You may also see our other Disability Forms for more samples and information.
  • Short Term Disability Claim Form – This is filed by an employee when he is sick or injured, and is unable to go to work for a certain period of time. Short Term Disability Benefits are applied once the employee has gone beyond the sick days provided by his company. This typically covers a portion of the employee’s salary over a specific period of time, which is around 40 to 60 percent of the employee’s weekly gross income for a maximum of 52 weeks.
  • Long Term Disability Claim Form – In the case where the employee has already reached the maximum period of time covered under his Short Term Disability Insurance, he may then apply for a Long Term Disability Claim. This usually starts after 52 weeks of being absent, and covers about 50 to 60 percent of the employee’s weekly gross income, depending on the policy. This insurance stops once the employee has recovered and returned to work, or for a number of years stated in the policy.

Income Claim Forms

Income Claim Forms are used to file a claim for income support. Income support is financial support or aid provided to people who have low income that is not sufficient to provide for their basic needs. A person does not have to be unemployed to qualify for Income Support.

Who Can Get Income Support?

  • A single parent caring for a child under the age of 5
  • Sick and disabled persons who are unable to work temporarily
  • People on parental or maternal / paternal leave
  • Women who are pregnant

Income Support is provided monthly by the government. If the person filing the claim has any savings, it may affect the approval of his claim, depending on how much his savings are.

Things to Keep in Mind When Filing a Claim

  • Always use a polite, friendly, and professional tone, even when you feel you have been wronged.
  • Always fill out necessary forms completely and accurately, and provide necessary documents to substantiate your claim, so that your claim will be approved. Review all the information that you will place in a claim form before submitting it as necessary changes will already be hard and tedious to do once your claim form is already being processed.
  • If your claim is denied, you may apply for a reconsideration or an appeal. There are certain procedures to be followed when filing for an appeal, depending on the regulations in your state. If you are not satisfied with the result of an appeal, there are also further steps you can take, which also depends on the regulations of your state.

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