transparent 14 East Highland Avenue | Philadelphia, Pennsylvania U.S.A. 19118
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If You Have a Claim

In-Hospital Benefits | Accidental Loss of Life | Professional Liability | Personal Property | Change of Beneficiary

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In-Hospital Benefits

Click here to download the form.

Complete the Association Member section of the form.

Have the reverse side of the form completed and signed by the Attending Physician.

Return the fully completed form and the itemized hospital bill to the Administrator who will submit the form to the assigned Claim Office.

Retain a copy for your records.

 
 

Accidental Loss of Life

Click here to download the form.

Complete all items on the form.
Attach a copy of the following documents:
Certified copy of death certificate (required for all claims)

Certified copy of all documents supporting claimant’s authority
(e.g., Letters of Testamentary, Letters of Administration, Guardianship Papers, etc.)

Copies of all police reports, newspaper articles, etc. describing accident


Send the completed and signed form
and all required documents to:

The Hirshorn Company
14 East Highland Avenue
Philadelphia, PA 19118

Retain a copy for your records.

 
  Professional Liability

Please provide contact information and a situation summary to Anne Hennessy at ahennessy@hirshorn.com or fax to 215-247-6366.
 
  Personal Property

1) Foreign service assignment, email address, telephone numbers, best ‘local’ time (your time zone) for us to contact you

2) A letter, fax or e-mail describing the circumstances of the loss. A date on which the loss was discovered should be included.

3) A description of the damaged or lost items and a copy of a bill or sale or replacement estimate to support the figures.

4) A copy of a letter to the shipper or storage facility notifying them that your are filing a claim with us. This is important so that the insurance company can subrogate against them, if applicable.

5) If the item was stolen, a police report is required.

6) If the item was scheduled, we need a description and the item number from the schedule list.

7) A storage inventory list for storage claims.

8) A copy of the contract between the shipper or carrier or storage company and you if one exists.

9) All of the above, plus a bill of lading, for a Transit Claim.

10) Surrender of entire Transit Policy, with your name written across the front page, for Transit Claims.

Please contact me if you have questions or would like to discuss your claim.

Katherine A. Hoffman
Claims Department
khoffman@hirshorn.com
Fax 215-247-6366
800-242-8221
 
 

Change of Beneficiary

Click here to download the form.

Complete the form and return it to:

The Hirshorn Company
14 East Highland Avenue
Philadelphia, PA 19118

 

If you have any questions,
please contact The Hirshorn Company
AFSA Plan representative by email
or telephone at: (215) 242-8200 | (800) 242-8221