|Proper claims handling is a vital component of any insurance organization—and K&K Insurance is known for the exceptional service that our in-house Claims Department offers. Staffed with experienced examiners, litigation specialists and management personnel who specialize in claims investigation, analysis and disposition, K&K provides superior services at the time when it is needed the most. To report a claim, please fill out and submit one of the forms below.
Participant Accident Claims
Before using the generic form below, check with your school district, organization, or their websites, for any special instructions or special claim forms that are used to submit a claim. Organizations such as USA Hockey, USSSA, USASA, AABC, AYF/AYC, USA Judo, Babe Ruth Baseball, USA Field Hockey, or USYSA may have claim forms that have been customized for their activities and specific instructions for levels of claim validation before the claim is sent to K&K. Click here for Tips for Submitting Participant Accident Claim.
Download claim form (pdf)
|Our Claims Department can be contacted directly at 1-800-237-2917:
|Property & Casualty Claims
Participant Accident Claims
Hartford Notice to Certificate Holders - NY and IL
New York's domestic violence law provides, in relevant part, that if any person covered by an insurance policy delivers a valid order of protection to the insurer is prohibited for the duration of the order from disclosing to the policyholder or other person the address and telephone number of the insured, or of any person or entity providing covered services to the insured. If a child is a covered person, then the right established by this section may be asserted by the child's parent or guardian. Illinois law provide similar protections for victims of actual or threatened violence, including domestic violence.
Health insurers/companies subject to the New York and Illinois Regulations are required to accommodate a reasonable request made by a person covered by an insurance policy to receive communications of claim-related information by alternative means or at alternative locations if the person clearly states that disclosure of the information could endanger the person. If a child is the covered person, then this right be asserted by the child's parent or guardian.
The Hartford has established procedures so that our New York and Illinois certificate holders who are victims of domestic violence or are otherwise endangered may receive claim-related information by alternative means or at alternative locations, or to revoke such a request. However, if you have filed a claim with a Third Party Administrator (TPA), you must contact your TPA in order to take advantage of these procedures.
If you have filed a life or health claim, you may take advantage of these procedures by either delivering a valid order of protection or making a reasonable request by completing and submitting a Confidential Communication Request Form to The Hartford or your TPA. A reasonable request will never require any justification.
You may make a reasonable request via telephone as long as you follow up with the submission of a completed Confidential Communication Request Form to The Hartford or your TPA. If you have multiple claims with The Hartford and/or your TPA, you must submit a reasonable request for each claim. You may revoke a reasonable request by submitting a separate written, notarized communication to The Hartford or your TPA.
If you have filed a life or health claim with The Hartford's TPA and would like further information on or to take advantage of these procedures, please contact your TPA or send your Confidential Communication Request Form to the appropriate address or fax number listed below
Specialty Benefits, Inc.
1712 Magnavox Way
PO Box 2338
Ft. Wayne, IN 46801
Phone: 800-237-2917 Option 1
For New York Residents:
For further information on domestic violence services, you may contact the NYS Domestic and Sexual Violence Hotline by dialing 1-800-942-6906, 1-866-604-5350 (TTY) or by accessing the website for the New York State Office for the Prevention of Domestic Violence at the following link: http://opdv.ny.gov/help/dvhotlines.html.
For Illinois Residents:
For further information on domestic violence services, you may contact the State of Illinois Domestic Violence Helpline by dialing 1-877-TO END DV or 1-877-863-6338 (Voice), 1-877-863-6339 (TTY) or by accessing the website for the Illinois Department of Human Services Domestic Violence Victim Services at the following link: https://www.dhs.state.il.us/page.aspx?item=30275.
The Hartford(R) is underwriting companies Hartford Life and Accident Insurance Company and Hartford Life Insurance Company and administrator Hartford-Comprehensive Employee Benefit Service Company.