Claim Instructions

1. After you receive treatment, download and complete the following insurance claim form with your information and the policy No.
   • 2008-2009 insurance claim form Policy No. DSP00026-08;
   • 2007-2008 insurance claim form Policy No. DSP00026-07;

2. Mail the claim form and all medical and hospital bills to:
   
   Personal Insurance Administrators, Inc.
   P.O. Box6040,
   Agoura Hills, CA 91376-6040

3. A claim must be submitted within 90 days after an injury or Sickness has occurred in order for the claim to be paid.

4. If you have questions about the status of your claim after it has been submitted, call 1-800-468-4343 and specify the policy No.