Below you will find useful information about the
Lake Washington Institute of Technology
Student Injury Only Insurance Plan & ICS Insurance Plan
Helpful Quick Links
Use your insurance
Find plan documents
and forms here
Get your medical bills paid
In most cases, the provider will NOT submit the claim for you. You must complete a claim form for a claim to be processed.
There are separate claim forms for the Accident Only and ICS Plan.
If you are injured in an accident NOT during play or practice of a College-sponsored sport, fill out the Accident Only Claim Form. If you are injured during play or practice of a College-sponsored sport, fill out the ICS Claim Form.
Download a claim form below, and send the completed form with all bills and receipts for medical treatment to:
Relation Insurance Services
P.O. Box 25936
Overland Park, Kansas 66225
Keep copies of all the documents submitted for claims. If you have questions about claims, contact Relation Insurance Services at (877) 246-6997 or firstname.lastname@example.org.
Confidential Communication Request
If you would like to have confidential medical information from the claims administrator sent to an address other than the address on file with your school, you can download a Confidential Communication Request, fill out the form, and send it to the address listed. This form is available below.