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How to Use Texas Clm 2

Filing a Texas CLM 2 form is necessary when a student gets injured and there is a need to initiate a claim for possible coverage under the Texas Kids First insurance plan. This form is key to ensuring the insurance company receives all the relevant details concerning the incident, allowing for a smoother process in assessing and potentially covering medical expenses that arose due to a school-related or non-school related accident covered under a 24-Hour coverage policy. Follow these steps meticulously to ensure your claim is processed efficiently and effectively.

1. Begin by downloading or obtaining a copy of the Texas CLM 2 form. It's essential to have a physical or digital copy to fill out.
2. Section 1 - Notice of Injury:
• Fill in the name of the School District and the specific School attended, including the School Phone Number.
• Provide the Name of the Injured Student, select their gender (Male / Female), and enter their Grade.
• Specify the Date of Injury, including the Time of Injury, marking AM or PM as appropriate.
• Indicate the Part of Body Injured, selecting Right Side or Left Side when applicable.
• Mention under whose supervision the injury occurred and whether the accident was witnessed, including the name of the witness if applicable.
• Detail the type of activity during which the accident happened (Interscholastic UIL Activity / Non Interscholastic UIL Activity), and specify the Sport/Activity.
• Provide a detailed explanation of how and where the injury occurred in the space provided.
• Have the form signed by a School Official, including their Title and the Date.
3. Section 2 - Parent/Guardian Statement:
• Enter the Name of the Student again along with their Date of Birth and Home Phone No.
• Indicate whether the student is covered by any insurance plan, specifying the Policy No. if applicable.
• Fill in the Parent/Guardian Name and Relationship to the Student.
• Provide the residential Address in full detail (Street, City, State, Zip).
• Complete the sections regarding both the Father’s and Mother’s Name, Employer, and their respective Insurance Company information—if no insurance exists, write “None.”
• Signify the consent for information disclosure by signing at the bottom of the section after thoroughly reading the authorization note. This should be done by the Parent/Guardian, along with providing the Date and Printing the Name of the Student.
4. Once both sections are completely filled out, review the form to ensure all information is accurate and no detail has been overlooked.
5. Submit the completed claim form to the Claims Office at the address provided or send it electronically to the specified email. This submission should be made within 90 days from the date of the injury.
6. After submitting the claim form, retain a copy for your records and wait for further instructions from the Claims Office, which may include the submission of additional documentation such as itemized bills or Explanation of Benefits (EOB) from your primary insurance.

Remember, filling out this form accurately and in a timely manner is crucial to ensure the claim is processed smoothly. If there are any questions or if any part of the process seems unclear, don't hesitate to reach out to the contact number provided on the form for assistance.

What is the Texas CLM-2 form designed for?

The Texas CLM-2 form is specifically designed as a Student Accident Claim Form. It serves as the formal documentation required for initiating a claim regarding an injury that a student sustains while at school or participating in school-related activities. This form is processed by the Fidelity Security Life Insurance Company via Universal Fidelity Life Insurance Company. It requires detailed input about the injury incident, including specifics about how and where the injury occurred, supervision details, and witness confirmation, in addition to comprehensive parental or guardian information regarding the student's insurance coverage.

Who is responsible for completing the Section 1 of the form?

Section 1 of the form is primarily to be completed by a school official. This section gathers detailed information about the injury, such as the time, date, location, and nature of the injury, along with verifying if the accident was witnessed. However, if 24-Hour coverage was purchased and the accident is not school-related, a parent or guardian is responsible for completing this section instead.

What are the steps involved in filing a claim with the Texas CLM-2 form?

1. Firstly, complete and submit the Texas CLM-2 claim form to the Claims Office via the provided address or email it to SAclaims@uflic.com. It is mandatory to submit this form within 90 days from the date of the injury.
2. Secondly, ensure to file a claim with your primary insurance initially, providing copies of all relevant bills to them.
3. Thirdly, after receiving payment or Explanation of Benefits (EOB) from your primary insurance, you should then submit a copy of the CLM-2 form, along with itemized bills and the EOBs from your primary insurance, to the stated address.

How can I find a provider within the Texas Kids First Provider Network?

The Texas Kids First Provider Network (TKF Network) comprises medical professionals and hospitals agreeing to treat insured students under the stipulations outlined in the Schedule of Benefits. To find a contracted provider within this network or to verify acceptance of full assignment, you can visit the website www.texaskidsfirst.com or call 1-800-366-8354 for assistance.

What should be done if there is other insurance coverage available for the student?

If the student is covered by another insurance plan, the Texas CLM-2 form still needs to be filled out and submitted. However, the process requires that any medical expenses be first submitted to the primary insurance coverage. The school’s policy acts as supplemental insurance, potentially covering charges beyond what your primary insurance does not cover. You must keep meticulous records and provide copies of all transactions, including the primary insurance’s Explanation of Benefits, to ensure proper coordination between the primary insurance and the supplemental school insurance policy provided through the CLM-2 form process.

When filling out the Texas CLM 2 form for a student accident claim, attention to detail is paramount. However, common mistakes can complicate or delay the processing of a claim. Understanding these pitfalls can make the submission process smoother and more efficient.

1. Not completing all required sections: Section 1 must be filled by a school official or a parent/ guardian if the coverage is 24-hour and non-school related, and Section 2 by the parent/guardian. Skipping sections or providing incomplete information can result in claim denial.

2. Failing to accurately specify the details of the injury, such as the exact part of the body injured and whether the injury happened on the right or left side. This precise information is crucial for processing the claim efficiently.

3. Overlooking the signature and date fields at the end of both sections. These are critical for validating the claim. Unsigned forms are considered incomplete and cannot be processed.

4. Not providing detailed information on other insurance coverage. If a student is covered by another insurance plan, all relevant details, including the policy number and insurance company name, must be disclosed.

5. Incorrectly or incompletely reporting the accident details, such as failing to state how and where the injury occurred, under whose supervision, and if it was witnessed. Clear, detailed accounts support the legitimacy of a claim.

6. Forgetting to include a photocopy of the medical authorization as part of the claim. This oversight can delay the processing time as the insurance company may require authorization to obtain and verify medical records.

7. Not adhering to the submission deadline. Claims must be submitted within 90 days from the date of the injury. Late submissions might not be considered eligible for coverage.

To avoid these common mistakes:

• Ensure all sections of the form are thoroughly completed.

• Review the form for accuracy, especially in detailing the injury and accident circumstances.

• Sign and date the form where indicated.

• Include all necessary documentation, such as other insurance details and medical authorizations.

• Keep a keen eye on the submission timeline to ensure compliance with the 90-day rule.

By paying attention to these areas, claimants can improve the chances of a smooth and timely claim process.

When dealing with an accident involving a student, the Texas CLM-2 form is crucial for initiating the claim process with the insurance company. However, to ensure comprehensive handling and proper processing of claims, several other forms and documents might be required or prove useful alongside the Texas CLM-2 form. Below is an overview of such forms and documents.

1. Accident Report Form: Schools often use this internal document to record the specifics of an incident. It includes details about the student involved, the nature of the accident, and any immediate actions taken.
2. Incident Witness Statement Form: If the accident was witnessed by individuals other than the injured party, their accounts may be recorded using this form. It helps in providing additional perspectives on the incident.
3. Medical Record Authorization Form: This allows the school or insurance company to request and obtain medical records related to the accident. It is necessary for verifying treatments and understanding the extent of injuries.
4. Insurance Policy Document: Understanding the coverage, exclusions, and limits of the applicable insurance policy is crucial. This document outlines what costs might be covered in the event of an accident.
5. Explanation of Benefits (EOB): After the primary insurance processes a claim, they provide an EOB. This document details what costs were covered, what was patient responsibility, and how benefits were applied.
6. Release of Liability Form: In some cases, where activities led to an accident might pose legal questions, a release form might be signed. This typically releases an entity or individual from liability in exchange for a settlement.
7. Parental Consent for Treatment Form: Should the student require emergency or further medical treatment, this form, signed by a parent or guardian, will authorize medical providers to proceed.
8. Third Party Liability Claim Form: If the accident involves a third party that might be held responsible, this form could be filed to seek reimbursement from the party’s insurance.
9. Physician's Report Form: This form is completed by the attending doctor, detailing the nature of the injury, the treatment administered, and the prognosis. It is vital for the claims process to substantiate medical claims.

Each of these documents plays a specific role in ensuring that the claims process is handled efficiently and effectively. Whether it's for verifying details, providing evidence, or authorizing treatment, having the right documentation is key to supporting the needs of the injured student. It's also important for schools and parents to understand the purpose of each form and document to navigate the claims process smoothly.

The General Accident Report Form serves a similar purpose to the Texas CLM 2 form, focusing on documenting incidents that could result in injuries or damages. Both forms require detailed information regarding the incident, such as the date, time, and nature of the injury, yet the General Accident Report Form is utilized in a broader range of environments beyond educational settings. This flexibility allows for comprehensive documentation in workplaces, public venues, and private entities, facilitating the process for insurance claims or legal actions if necessary.

The Health Insurance Claim Form (HCFA-1500) shares similarities with the Texas CLM 2 form by standardizing the process for submitting medical claims to insurance companies. The HCFA-1500 is designed specifically for healthcare services, demanding precise information on the medical provider, the patient, and the treatment received to expedite the insurance reimbursement process. Both forms act as crucial liaisons between the insured party and insurance providers, ensuring accurate and timely financial resolution for medical services rendered.

The Workers' Compensation Claim Form parallels the Texas CLM 2 form by gathering essential details following a workplace injury, aimed at securing coverage for medical expenses and lost wages. This document differs by its exclusive application to employee injuries occurred in the course of employment, encompassing a range of incidents from minor injuries to severe accidents. It underscores the employer's role in maintaining a safe work environment and their obligation to support injured workers through the workers' compensation insurance system.

The Automobile Accident Report Form is akin to the Texas CLM 2 form, specifically tailored to document vehicle accidents. This form captures comprehensive data regarding the accident, including driver information, vehicle details, and a narrative of how the accident occurred. The key similarity lies in their importance for insurance processing, facilitating claims related to vehicle damage or bodily injury. However, the Automobile Accident Report Form exclusively addresses incidents involving motor vehicles, highlighting the specialized nature of insurance documentation.

The Dental Claim Form bears resemblance to Texas CLM 2 form in the context of submitting dental treatment details to insurance providers. This form requires specific information about dental procedures, diagnoses, and the associated costs, mirroring the structured approach to insurance claims evident in the CLM 2 form. While dedicated solely to dental services, it facilitates the reimbursement process for patients, ensuring dental care is accessible and financially manageable.

The School Incident Report Form, much like the Texas CLM 2 form, is utilized within educational institutions to document occurrences that might affect students’ wellbeing, ranging from accidents to behavioral issues. The primary goal is to ensure a safe learning environment by addressing incidents promptly and effectively. Although focusing on a broader spectrum of school-related incidents, it shares the objective of creating an accountable and transparent process for handling situations that impact student safety.

The Professional Liability Insurance Claim Form aligns with the Texas CLM 2 form by providing a means for professionals to report incidents that could lead to liability claims. This includes errors, omissions, or negligence in professional services that result in financial loss or injury to clients. Like the CLM 2 form, it plays a critical role in the claims process, albeit in the context of professional liability, highlighting the importance of accurate documentation in mitigating risk and protecting professional integrity.

The Property Damage Claim Form is designed to report damages to property, paralleling the Texas CLM 2 form’s function in the realm of personal injury. This form is critical for homeowners, renters, or business owners seeking to document and claim compensation for property losses due to various causes, such as natural disasters, theft, or vandalism. Both forms facilitate the interaction between the claimant and insurance companies, albeit focusing on different types of claims—personal injury versus property damage.

The Disability Claim Form serves a purpose similar to the Texas CLM 2 form by documenting conditions that limit an individual's ability to work, aiming to secure disability benefits. It requires detailed medical information and proof of disability, ensuring individuals receive financial support during their period of incapacity. Both documents bridge the gap between the affected party and benefits providers, although the Disability Claim Form is specifically targeted at compensating for loss of income due to health-related work restrictions.

The Life Insurance Claim Form is related to the Texas CLM 2 form in its primary function of initiating a claim process following a significant life event; however, it is specifically used in the event of a policyholder’s death. This form requires documentation certifying the death, policy details, and the claimant's relationship to the deceased, facilitating the disbursement of life insurance benefits. While serving different circumstances—student accidents versus life insurance claims—both forms underscore the importance of accurate, timely information in the resolution of insurance matters.

When it comes to completing the Texas CLM 2 form for student accident claims, it's crucial to pay attention to detail and to follow the guidelines carefully to ensure the process moves smoothly. Below are essential dos and don'ts to guide you through this process.

• Do read the entire form and instructions before starting to fill it out.
• Do ensure that Section 1 is completed by a school official if the accident is school-related, or by a parent/guardian if it occurred during a non-school activity and 24-Hour coverage was purchased.
• Do complete Section 2 thoroughly, providing all necessary information about the student, their insurance, and the details of the parent or guardian.
• Do keep a copy of the completed form for your records.
• Don't leave any fields blank. If a section does not apply, write "N/A" (not applicable) to indicate that you did not overlook it.
• Don't rely on the medical provider or facility to submit your claim form. It's your responsibility to send it to the address provided or electronically, as indicated.
• Don't delay in submitting the claim form and any supporting itemized bills. Forms should be submitted within 90 days from the date of the injury.
• Don't forget to first file a claim with your primary insurance before submitting the claim form to the school's insurance provider, as the school's policy is considered supplemental.

Adhering to these guidelines will assist in the accurate and timely processing of your claim, ensuring that you maximize the benefits available for covering the student's medical expenses.

Understanding the Texas CLM 2 form, a student accident claim form, is crucial for parents and guardians in navigating school-related incidents. However, misconceptions are common. Here are eight misconceptions debunked:

• Only school officials can complete Section 1 of the form. While it is primarily designed for completion by school officials, a parent or guardian can also complete this section if the student is covered 24-hour and the accident occurred outside school activities.

• The form is only for sports-related injuries. This is not true. The form covers any injuries sustained by the student while participating in school activities, not just sports.

• All medical costs are covered. Unfortunately, the policy is a supplemental Accident Only Policy, which means it may not cover all medical expenses. Any uncovered charges are the responsibility of the parent or guardian.

• Parents don't need to act if they have other insurance. Parents should first file a claim with their primary insurance. After that, they can submit the CLM 2 form along with itemized bills and an Explanation of Benefits from their primary insurance to potentially cover additional costs.

• The school will file the claim on behalf of the student. While the school may assist in the process, it is ultimately the responsibility of the parent or guardian to file the claim and ensure all necessary documentation is submitted.

• The form covers injuries 24/7, regardless of whether it’s school-related. Only accidents occurring in school activities are covered unless the student has 24-hour coverage, which then includes accidents outside school activities.

• Submitting the claim form is all that's required for processing. Besides the claim form, parents or guardians must submit itemized bills and, if applicable, the Explanation of Benefits from their primary insurance. Simply submitting the claim form is not sufficient.

• There’s no time limit for submitting the claim. Claims must be submitted within 90 days from the date of the injury. Delaying beyond this period may result in the claim being denied.

Understanding these details helps ensure that parents and guardians can navigate the claims process more effectively, ensuring that students receive the coverage and care they need in the event of an accident.

Understanding the process for completing and utilizing the Texas CLM 2 form is essential for properly submitting student accident claims. Here are six key takeaways regarding the form:

• The CLM 2 form is divided into two main sections: Section 1 (Notice of Injury) must be filled out by a school official for school-related accidents or by a parent/guardian if the incident occurred off school grounds and is covered by 24-Hour coverage. Section 2 (Parent/Guardian Statement) is exclusively for the parent or guardian to complete.
• Claims must be submitted within 90 days from the date of injury, whether or not the student has other insurance coverage. This timeframe is crucial to ensure the claim is considered and processed in a timely manner.
• Proof of the accident and the expenses incurred, such as itemized bills (which often include diagnosis codes, procedure codes, and the provider's Tax ID number), must be provided with the claim form. Keeping a copy of all documents submitted for your own records is strongly recommended.
• Parents or guardians should file a claim with their primary insurance before submitting the CLM 2 form to the specified address, along with any supporting documents like itemized bills and Explanation of Benefits (EOB) from their insurance. This is because the school's policy acts as a supplemental insurance.
• In cases where the injured student does not have any other insurance, the supplemental Accident Only Policy provided by the school may serve as the primary coverage. However, this policy is limited and may not cover all medical bills.
• The Texas Kids First Provider Network offers a "no balance bill" feature for students insured under the Texas Kids First Student Accident Plans without other insurance. It's beneficial to check the network's list of providers to ensure the needed services are covered and to minimize out-of-pocket expenses.

It's also important to note that any deliberate attempt to submit a fraudulent claim can lead to legal consequences, including fines and potential imprisonment. Therefore, ensuring that all provided information is accurate and truthful is not only a matter of integrity but also a legal obligation.