Critical Illness & Accident Claim Form – ufcw312.org

March 22, 2024

UFCW Local 312 Benefit Fund Critical Illness & Accident Claim Form Instructions Member must complete Section A and provide Medical Documentation that supports the claim being filed and return to the Benefit Fund office within 90 days of occurrence. Section A (To be completed by member)

http://ufcw312.org/forms/ClaimFormCIandA.pdf

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