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If we have requested additional accident/injury information from you, you may print this form and submit it to us instead of the form we send in the mail.
When filling out the form, you will just need to complete sections 1, 2 (if applicable), 3, and 8.
Your Fund Office is here to make sure you get the most out of your benefits. Keeping that in mind we would ask for additional information on any claim that has an accidental/injury diagnosis. By you providing this information we will be able to determine if anyone else may be responsible for your accident/injury. The Fund Office does not cover worker's comp or third party accident/injury claims. Once you have completed the form, please send it back to us as soon as possible so we may continue processing your claim.
You may mail form to:
Specialties & Paper Products
PO BOX 641
Mableton, GA 30126
Or fax:
770-944-0978
Thank you for all you assistance,
Fund Office
Download:
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