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Uninsured Employers Benefits Trust Fund

When the Uninsured Employers Benefits Trust Fund (UEBTF) is the claims administrator, follow these instructions to Print and Mail bills to them.

Note: UEBTF does not accept electronic bills or provide a central billing fax number. Some UEBTF adjustors will accepted bills faxed directly to them, but only on a case by case basis.

Step 1. From the Edit Injury Page, Search ‘Uninsured Employers Benefits Trust’ as ‘Claims Administrator’

Choose either the Southern California address (based in Los Angeles) or the Northern California address (in Oakland).  If unsure, contact UEBTF for the correct claims address.

Step 2. Submit Bill, choose ‘Print and Mail’ as the submission method, click ‘Submit’

If the adjuster has agreed to accept bills by Fax select Fax and enter Fax Number.

Step 3. Download a PDF of the bill

Step 4. Print and Mail CMS1500 (HCFA) and Supporting Documents to the Uninsured Employers Benefit Trust Fund

That’ll do the trick!

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