Skip to main content
Important information about the Culinary Health Center
Latest COVID-19 information for
Participants Providers Employers

Accidents and injuries

If one of your patients is hurt in an accident and it may be someone else’s fault, let us know. We will send the patient a letter and forms asking for information about the accident. It’s important for them to complete these forms. We can’t pay any of their medical bills until they do.

Your patient 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

If your patient has a lawyer, the lawyer should sign the Repayment Agreement form.

No claims will be paid until all 4 of the forms are completed, signed, and returned by both your patient and their lawyer, if they have one.

Why do my patients need to fill out these forms after an accident?

If the accident is someone else’s fault, your patient 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 related to the accident.