getting ready > Insurance > asv claim form



Accident and Sickness For Volunteers
Claim Information

Documentation Needed

Accident or Sickness

Disability or Dismemberment
  • AIG Dismemberment Claim Report (both sides completed)
  • Police report, if applicable
  • Medical reports
  • Any other pertinent items specific to the case

Death
  • AIG Proof of Death form completed and signed by employer and by beneficiary as indicated
  • Death Certificate–certified copy or original
  • Police report
  • Autopsy report, if applicable

Adventist Risk Mangement Inc.
Attn: Irma Johnson, Claims
12501 Old Columbia Pike
Silver Spring, MD 20904

Phone: (301) 680-6867
Fax: (301) 680-6878
E-mail: ijohnson@adventistrisk.org
Back to top