Most Frequently Asked Questions from participant accident claimants
What coverage does the NHRA Participant Accident policy provide?
The Participant Accident policy pays up to the policy limit for 1) reasonable medical expenses incurred by a participant who sustains 2) an accidental race related injury while 3) participating in a covered event. All medical treatment must be performed by a 1) legally qualified physician and must be 2) for the sole purpose of treating the injury. The policy also provides, up to the policy limits, a Disability benefit, (subject to a waiting period) following a covered claim, and an Accidental Death and Dismemberment benefit.
How do I file a claim?
Just complete the claims forms forwarded to you by the claims representative and return them to their office along with your medical bills, if you have received any. Since coverage is "Excess", your medical bills must be processed under that coverage first. Any deductible, co-pay, and/or coinsurance amounts you are responsible for can be submitted. In most cases, in order for the claims representative to process payment to your doctor or hospital, you will need to provide a complete itemized statement, along with a copy of your insurance company's Explanation of Benefits (EOB). If you need to file an Accidental Death or Dismemberment claim or a Disability claim, please call your claims representative. If you are not sure whom to call, contact Ms. Lori Terry at (626) 250-2219.
Will the Participant Accident policy pay all of my bills if I don't have any other insurance?
Since every insurance policy has exclusions and limitations, it is possible that the policy may not cover all of your bills. Common reasons for this include, but are not limited to:
1. The bill is higher than what a "reasonable expense" or a "usual and customary charge" should be in your area.
2. The injury is not considered accidental.
3. The bill is unrelated to the covered injury.
4. The doctor or hospital has not provided us with all of the information needed to pay the bill.
I have other insurance. Will the Participant Accident policy pay all of the bills my insurance does not?
While the Participant Accident policy will reimburse you for any deductible or co-payment you may be responsible for, it will not reimburse you for charges that your insurance company does not pay because they exceed "reasonable expenses" or the "usual and customary" allowance.
What does "reasonable expenses" or "usual and customary allowance" mean? Is this just another way to avoid paying a claim?
Most medical plans, exclude reimbursement for medical charges that are higher than those generally made in the local area where treatment is received. If your insurance company does not pay a bill in full because the charges exceed "reasonable expenses" or the "usual and customary allowance," those expenses are not likely to be paid under the Participant Accident policy, either.
Do I have any obligation to pay bills that have been turned down because they are higher than "reasonable expenses" or the "usual and customary allowance?"
When you receive treatment from a doctor or hospital, you usually sign an agreement with the doctor or hospital stating you are ultimately responsible for payment of their bill. However, you do have the right to question the validity of the doctor or hospital's charges.
When will the bill from my claim be paid?
Normal processing time is three weeks to four weeks from the date the claims representative receives your bill and all of the essential paperwork. Please be sure that your submission of paperwork is complete in order to avoid any delays.
Some of my bills are over 30 days old. Why haven't they been paid?
- Since the Participant Accident policy is excess over your Health insurance coverage, you need to be sure you provided a copy of the Explanation of Benefits (which indicates what they paid or denied on your medical expenses).
- The claims representative may be waiting for additional information requested from the provider. If this situation exists, you can help them calling your provider and getting the requested information.
- The claims representative may never have received the bill. If you are unsure, resubmit it.
This is only a brief description of the coverage that the Participant Accident policy provides. All claims are subject to policy provision, limitations, and exclusions.
If you have any questions regarding coverage, how to complete the forms, where to send your claim and medical bills, or the status of the claim, please call your claims representative first. If you still have problems, please call Ms. Lori Terry at (626) 250-2219, or email her at email@example.com.