Forms

Here you will find a current collection of Seven Corners’ claim forms for our travel medical, student/study abroad, global insurance, visitor and immigrant medical programs.

Appeal a Claim

Claims Appeals received in writing with supporting medical information will be addressed by Seven Corners within 30 days of receipt.

1. Download our sample letter form to your desktop, fill out your information, and save the letter.
2. Include as much detail as possible to explain why you believe your claim should be paid. Make sure to provide the information shown in red, as we need this to properly identify your claim.
3. If you have additional information we have not received, such as medical records, attach them to the letter. Please note that we have a mailbox limit of 10MB for attachments. If you have a larger attachment, please send it separately.
4. Mail
   Seven Corners, Inc.
   Attn: Appeals
   303 Congressional Boulevard
   Carmel, IN 46032 USA
   
   Fax: (+01) 317-575-2256
   email: qualityassuranceteam@sevencorners.com

Understanding the Appeal Process

If your claim has been denied, and you’ve received a letter from us explaining why it was denied, you have the option to appeal our decision. Simply disagreeing with our decision is not sufficient to change the denial. Your claim was processed by licensed analysts who are trained at interpreting policy language.

The original determination will remain in place unless we receive documented proof that an error occurred. This means that you must submit additional documentation, not previously considered, in order to file an appeal.  If you simply disagree with the determination without supporting documentation, this will be considered correspondence only and be handled accordingly.

When you send us your appeal letter, it must identify the reason you believe an error was made:

• Factual
• Is the effective date incorrect? You need to provide proof of the different effective date such as purchase request, confirmation, etc. 
• Was there an error in the medical records? You need to provide corrected medical records, along with a written explanation from the medical provider (physician, hospital, therapist,etc.), where he or she explains the error. 
• Was pertinent information left off your original Proof of Loss form? You need to send us a corrected Proof of Loss, with the updated information identified. 

• Exclusions - Please review the exclusions section of your policy. If one or several exclusions are related to your claim denial, this is explained in our letter. You will need to provide documentation which proves that the exclusions do not apply. 
• Timeliness - Was your claim denied for timely filing?
  • You will need to submit proof of when you filed your claim if we received it after the required 90 days. 
  • If you submitted your claim more than 90 days after the date of service, you need to provide a written explanation of why you did not file your claim within the 90-day requirement.