File an Accident Claim

 

To begin your claim, contact Midwest Heritage at 515-343-5047 or [email protected]. A customer service representative will ask you for the following information to get the claim form started, and then mail the forms to you for completion.

• Employee name, social security number, and store location
• Current phone number, address and email address to contact claimant

 

When an employee receives the claim form from Midwest Heritage:

• Complete the Accident Claim Form in its entirety
• If your accident is due to a motor vehicle collision, we will require a copy of the police report for all motor vehicle accident claims and any other incidents investigated by any law enforcement agency.
• Please provide Physician’s documentation of your accident.
• Please provide documentation of your first date of treatment following your accident.
• If death was a result of the accident, please include a certified copy of the death certificate for the deceased.
• In order to document the contents of the form, the Insured and Claimant (if an adult) must sign and date the completed claim form.

 

Send the completed claim form with the appropriate itemized bills to:
Midwest Heritage Insurance
1025 Braden Ave.
Chariton, Iowa 50049

Fax: 641-774-2022
Email: [email protected]

Depending on the facts and circumstances relating to the accident, additional information may be required to process your claim.