Below you will find the most commonly asked questions we receive regarding claims submission and processing. Do not hesitate to reach out to us, if your question is not addressed below by using our Contact Us form, here. We will respond within 48 hours of receipt of your question.
When do I need to submit the Student Accident Claim Form (SACF)? Do you have a filing deadline?
The SACF must be submitted within 90 days from the initial documented date of injury in order to qualify for any reimbursement.
NOTE: Treatment must commence within 30 days from the initial, documented date of injury by a licensed medical doctor(s).
What medical costs do you reimburse?
ADL Risk Services reimburses most Usual, Customary, & Reasonable out-of-pocket medical treatment costs associated with school-related accidents or injuries, as covered by your school’s supplemental student accident insurance plan. This type of coverage is often referred to as “Supplemental”, “Secondary” or “Excess” insurance, which means that claims for qualified out-of-pocket medical costs are submitted to us and processed for reimbursement AFTER all other primary, applicable and valid insurances (such a qualified major medical insurance plans) have been processed and paid toward the initial medical claim(s). (As an example, this often includes co-pay and co-insurance amounts.)
NOTE: The plans we managed have a one (1) year/52 week benefit period from the documented date of injury, meaning any medical costs incurred outside of this benefit period are not eligible for reimbursement. (Please also refer to the applicable filing deadlines above.)
What if I don’t have medical insurance?
If you do not have any form of medical insurance coverage, we will reimburse qualified out-of-pocket expenses, not to exceed Usual, Customary, & Reasonable (U,C,&R) rates.
Who should complete and submit the Student Accident Claim Form (SACF)?
A qualified school representative and the Parent or Guardian of the affected student must jointly complete the SACF to ensure all information is correct and complete. Incomplete SACFs will be denied and will not be processed.
How do I file a claim?
You can obtain the claim filing instructions along with the Student Accident Claim Form (SACF) directly from your school, or you can view and print these documents from the IMPORTANT DOCS section on our website. Please read these carefully to ensure all required information is complete and submitted at the time you submit your claim to us. This helps ensure timely processing and reduces denials.
Can I file a claim and be reimbursed directly, if my provider(s) will not bill you directly?
Yes. Once your primary medical insurance has been billed and has paid the portions they cover, request/gather the following documents for submission to us with your SACF: your primary carrier’s Explanation of Benefits (EOB) they should have provided to you once they processed the original claim (itemizes your services as well as any covered and non-covered amounts), all itemized medical bills, including the CMS-1500 (physician billing form) and UB-04 (hospital billing form). The itemized medical statements must, at minimum, show the Diagnoses, Date(s) of Service, any Service and Procedure Codes (e.g., CPT, HCPCS) for all procedures/services rendered, as well as all other necessary information for insurance processing. NOTE: Balance Due statements are NOT itemized bills and cannot be utilized to process your claim.
Is this major medical insurance?
No. Initial claims must always be submitted to and processed by all other applicable insurance companies first, including your primary major medical insurance carrier (with the exception of Medicaid – see above). The plans we manage are considered full excess plans (also referred to as supplemental or secondary) and are not meant to pay 100% of your medical costs. School-provided accidental injury insurance is NOT and can never become a major medical insurance plan. These plans are purchased by schools as an added benefit and courtesy for students and their families to help offset the financial burden of residual out-of-pocket medical costs, once primary insurance has paid their covered portion.
Can I be reimbursed directly, if I have already paid my out-of-pocket portion to my medical provider?
Yes. ADL can reimburse you directly, as long as you have thorough and proper documentation. You must submit a SACF to us within the filing period and must include a copy of any receipts or statements that verify your payments. In addition, all itemized bills and primary insurance Explanation of Benefits must be included. (For further explanation, see Can I file a claim and be reimbursed directly, if my provider(s) will not bill you directly? )