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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.

All fields are required unless marked as optional.

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Please enter the month, day and year of the patient's illness/injury.

Once you submit this information, we will update your file. If it is more convenient, you may call us with this information at (800) 821-6136. Thank you for your cooperation.