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Accident or Injury Form

If GEHA pays benefits for you or your dependent and you also receive (or are entitled to receive) reimbursement from another party, or from your own insurance (such as auto insurance), GEHA is required to recover its payments. This is called subrogation, or right of reimbursement, and is mandated by the Office of Personnel Management (OPM). Please refer to your Plan brochure under "When others are responsible for injuries" for a complete explanation.

If you have received a letter in regards to an accident or injury, please include the claim number on this form. The claim number can be found on the letter your received. 

If you have submitted a claim for which another party is responsible, this form will help document your claim.

Once you submit this information, we will update your file. If it is more convenient, you may call GEHA's Customer Service department with this information at (800) 821-6136.