Student Accident Claim Form

Procedure in Event of Claim

As soon as possible after your child sustains an accident, secure an A-G Administrators claim form from your school nurse or on the links below:
Student Accident Claim Form - English Student Accident Claim Form - Spanish
Read the instructions carefully, complete and sign the form then present it to your doctor and return it, together with bills, to our claims administrator:
Claim Administrator: A-G Administrators LLC Sports Insurance Specialists PO Box 21013 Eagan, MN 55121
The completed claim form must be submitted to the insurance company within the ninety (90) days' time limit from the date of the accident, as stated within the policy, even though further treatment is necessary.
It is the parent's responsibility to see that the accident claim form is processed by the doctor handling the treatment of the injury. The school has no control over the processing of claims, nor the amount of benefits paid by the insurance company. All inquiries should be directed to A-G Administrators.

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