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Customer Service will be closed July 4 for Independence Day.
The Culinary Pharmacies will be closed July 4 for Independence Day.
The Culinary Health Center will be closed July 4 for Independence Day.

Accidents and injuries

If one of your employees is hurt in an accident and it may be someone else’s fault, your employee should let us know. It’s important for them to complete the accidents and injuries forms. We can’t pay their medical bills until they do.

Your employee must complete all 4 of these forms:

  1. Accident inquiry formDownload PDF
  2. Repayment agreementDownload PDF
  3. Statement of factsDownload PDF
  4. Authorization for the release of Protected Health InformationDownload PDF

No claims will be paid until all 4 forms are completed, signed, and returned to the Culinary Health Fund. If your employee has a lawyer, they must sign the Repayment Agreement form

Why does my employee need to fill out these forms after an accident?

If the accident is someone else’s fault, your employee shouldn’t get stuck with the bills, and neither should the Fund. The other person may have to pay us back for some or all of the medical bills we cover.


Your employee is in a car stopped at a traffic light and is struck by another car from the rear. The employee is injured and receives medical treatment. The Culinary Health Fund pays $500 of their medical bills. Your employee makes a claim or files a lawsuit against the insurance company of the driver of the other car, or their own car insurance. The employee receives a settlement of $2,000. The employee must then reimburse the Culinary Health Fund the $500 which was paid before the settlement.

When a doctor notifies us that your employee has been hurt in an accident, they will receive a letter and forms in the mail asking questions about the accident.

  • Your employee should fill out and sign the papers.
  • If they have a lawyer, the lawyer should also complete the forms.
  • All completed papers should be sent back to the Culinary Health Fund.

If there is a lawsuit and a settlement is reached, your employee should make sure the settlement includes the future cost of health care related to the injury. Once a settlement is signed, the Culinary Health Fund may deny future claims.

Your employee must fill out, sign, and submit all of the forms. If they need help, they can call our Customer Service Office at 702-733-9938.