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2022 HSR Accident & Sickness Claim Form

CURRENT YEAR Claim form for Health Special Risk (HSR) insurance policy for incidents occurring in the calendar year 2022. Use this form to process a claim in the event of an accident or other applicable incident within 90 days. This form is only needed in the event of a claim. Fill out the form and process it directly through HSR, the third-party insurance company through which Cascade Pacific Council has purchased unit accident insurance for each Scouting unit. If your incident occurred in 2021, please use the 2021 form found below.

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