The RoamRight mark is used by Arch Insurance Company and owned by its affiliate, Arch Capital Group (U.S.). All insurance products offered and underwritten by Arch Insurance Company.
Accidental Dismemberment Claim Form
Do not use a public computer (e.g. internet cafe, public library) to complete this form
Complete the form with as much information as possible. Required fields are marked with an asterisk (ex: ). Some fields may be required based on your response to other questions.
On most modern web browsers, the data you enter will be periodically saved. If you need more time to complete this form, you can return to this computer and web browser later to complete the form. You must return to this computer and web browser to resume your claim form in progress - a different computer or different browser will not have your saved responses.
Clearing your browser cache may clear your saved claim form data
After completing the form, you will have an opportunity to upload documentation (ex: receipts) to support your claim.
The Claimant/Insured should complete and sign the Accidental Dismemberment Insurance Claim form in full and return it with the documentation noted below.
For all claims, submit:
Copies of the insured's travel documents confirming the travel dates and itinerary;
A copy of the accident report;
A copy of the police report of the accident;
Newspaper or other articles containing details of the accident;
Any other information or documentation that would help to explain the circumstances of the insured's accident and condition.