Frequently Asked Questions

The SAF must be submitted within 90 days from the initial documented date of injury in order to qualify for any reimbursement. If your SAF is submitted AFTER 90 days, you will have to go through an appeal process for reconsideration.  Claim filing instructions have been provided to your school district and may also be obtained on our website.

NOTE: Treatment must commence within 30 days from the initial, documented date of injury by a licensed medical doctor(s).  If treatment is performed after 30 days, your claim(s) will be denied. (Emergency Room treatment must occur within 72 hours of the initial injury date in order to be eligible for reimbursement.)

A qualified school representative and the Parent or Guardian of the affected student must jointly complete and sign the SAF.  The SAF consists of four (4) sections: Section 1 is for the school only.  Sections 2, 3, and 4 is for the parent or guardian only.  All sections must be completed accurately in order to avoid delays in the processing of your medical claim(s).  Incomplete SAFs will be denied. 

The Parent or Guardian is responsible for submitting a completed and signed SAF form to ADL. And, must be submitted within 90 days of the initial date of injury.  The SAF opens an injury file so that any eligible medical claims related to the injury does not result in delayed approval for processing.  Do not wait to be billed by the provider(s) before submitting this form. Do not expect or assume this form to be submitted by another individual (i.e., school rep, medical provider, etc.). Any medical claims we receive will be denied if we do not have the required SAF of the injured student.

You can obtain the claim filing instructions along with the Student Accident Form (SAF) directly from your school, or you can view and print these documents from the IMPORTANT DOCS section on our website. Please read these carefully to ensure all required information is complete and submitted at the time you submit your claim to us. This helps ensure timely processing and reduces denials.

Yes. Once your primary medical insurance has been billed and has paid the portions they cover, request/gather the following documents for submission to us with your SAF: your primary carrier’s Explanation of Benefits (EOB) they should have provided to you once they processed the original claim (itemizes your services as well as any covered and non-covered amounts), all itemized medical bills, including the CMS-1500 (physician billing form) and UB-04 (hospital billing form). The itemized medical statements must, at minimum, show the Diagnoses, Date(s) of Service, any Service and Procedure Codes (e.g., CPT, HCPCS) for all procedures/services rendered, as well as all other necessary information for insurance processing. NOTE: Balance Due statements are NOT itemized bills and cannot be utilized to process your claim.

Yes. ADL can reimburse you directly, as long as you have thorough and proper documentation. You must submit a SAF to us within the filing period and must include a copy of any receipts or statements that verify your payments. In addition, all itemized bills and primary insurance Explanation of Benefits must be included. (For further explanation, see Can I file a claim and be reimbursed directly, if my provider(s) will not bill you directly?)

It is a term that insurance companies use to describe a limitation on their responsibility to pay for eligible medical expenses.  In other words, UCR is the amount of money that a particular health insurance company (or self-insured health plan) determines is the normal or acceptable range of payment for a specific health-related service or medical procedure.  Each insurance company has their own methodology in how it calculates its numbers for medical services.  Note: Don’t overlook the fact that your policy may also have a deductible, coinsurance requirements.  Your deductible is the dollar amount that you will have to pay out-of-pocket before your insurance company will provide any benefits for any medical services.

Your deductible is the dollar amount that you will have to pay out-of-pocket before your insurance company will pay any benefits for any health care services. Coinsurance is your share of the cost for health care expenses once you’ve met your deductible, typically a percentage of the total cost of care. Your copay(s) is/are set amounts you’ll pay at the time of service (at the doctor’s office or pharmacy, for example). Deductibles, coinsurance, and copays are three primary forms of cost sharing measures imposed by your health insurance plan. However, the forms of cost-sharing do not include the premium you pay to the health plan each month.

The maximum amount a plan will pay for a covered medical service.  It is sometimes referred to “eligible expense”, “negotiated rate”, or “payment allowance”, as well.

Yes.  Please feel free to reach out to customer service support at toll-free 844.350.9897, Monday through Thursday 9:00AM to 4:00PM CST.

ADL Risk Services reimburses most Usual, Customary, & Reasonable out-of-pocket medical treatment costs associated with school-related accidents or injuries, as covered by your school’s supplemental student accident insurance plan.  This type of coverage is often referred to as “Supplemental”, “Secondary” or “Excess” insurance, which means that claims for qualified out-of-pocket medical costs are submitted to us and processed for reimbursement AFTER all other primary, applicable and valid insurances (such a qualified major medical insurance plans) have been processed and paid toward the initial medical claim(s).  (As an example, this often includes co-pay and co-insurance amounts.)

NOTE:  The plans we managed have a one (1) year/52 week benefit period from the documented date of injury, meaning any medical costs incurred outside of this benefit period are not eligible for reimbursement.  (Please also refer to the applicable filing deadlines above.)

If you do not have any form of medical insurance coverage, we will reimburse qualified out-of-pocket expenses, not to exceed Usual, Customary, & Reasonable (U,C,&R) rates.

No. Initial claims must always be submitted to and processed by all other applicable insurance companies first, including your primary major medical insurance carrier (with the exception of Medicaid – see above). The plans we manage are considered full excess plans (also referred to as supplemental or secondary) and are not meant to pay 100% of your medical costs. School-provided accidental injury insurance is NOT and can never become a major medical insurance plan. These plans are purchased by schools as an added benefit and courtesy for students and their families to help offset the financial burden of residual out-of-pocket medical costs, once primary insurance has paid their covered portion.

A charge is considered usual, customary, and reasonable if it matches the general prevailing cost of that service within your geographic area, which is calculated by your insurance company.  The insurance company then uses this information to determine how much it’s willing to pay for a given service in your area.