Sport Accident Claim Form Page 3

ACCIDENT CLAIM FORM INSTRUCTIONS

⇒ GameDay Insurance must receive notification of your accident within 30 days of it

occurring and receive your claim form within 90 days of the accident.

⇒ Complete attached Sport Accident Claim Form and Physician Statement. If your claim

is for dental injury have your dentist complete and submit a Predetermination Form.

⇒ Forward forms along with original copies of expense receipts to date to your broker.

• Pearson Dunn Insurance Inc.

435 McNeilly Road, Suite 103

Stoney Creek, ON L8E 5E3

1-800-461-5087

⇒ If you intend to make a claim but have not had out of pocket expenses to date,

complete and submit claim form indicating that receipts are to follow.

⇒ If you have questions regarding submission of forms please contact your broker.

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Parent category: Legal