CRPOA’s Accident Disability Plan, underwritten by Chubb, offers financial assistance for qualifying work-related injuries (related to a General Member’s law enforcement, search and rescue or volunteer in policing duties) which solely and directly (1) prevent the General Member from performing all the substantial and materials duties of the General Member’s regular occupation or, with respect to a member who is unemployed, from engaging in the normal and customary activities of a person of like age and sex in good health, (2) causes a condition which is medically determined by a medical doctor to be continuous, and (3) requires the continuous care of a medical doctor.
Download the complete Chubb Policy for review.
Complete the Temporary Total Disability form for all initial claims involving accidental temporary total disability. You will attach the following documents as applicable:
- Fully completed Attending Physician Statement (Required for all Claims)
- Copies of all police reports, newspaper articles and other relevant information describing the accident
- Copies of any additional documents that support your claim
- Documentation of employment income immediately prior to disability
- Documentation of all other sources of disability income
Send the completed and signed claim form and all required documents to:
California Reserve Peace Officers Association
P.O. Box 1238, Pacifica, CA 94044
Phone: (650) 290-6892
Fax: (855) 552-7762
Attach a PDF copy and email to: email@example.com