claims
pages
Toggle dark mode
Account settings
Service Providers
Browse Directory
View Provider Roster
Add Your Business
Daily Claims Resources
Tools & Databases
News Articles
Document Downloads
Event Calendar
Career Listings
Storm Watch
Industry Editorials
Technology
Newsletters
Receipt & Release Medical Payments Coverage (Spanish)
PDF (25KB)
Forms Property & Casualty
Sign-In To Download
This form is signed by those who qualify as insureds under a policy when collecting medical payments coverage. Used as both a receipt and a release.
