Policy Number: OA-2025-0120
Carrier: Travelers Insurance
Effective Date: October 15, 2025
Expiration Date: October 15, 2026
Insured: Robert Johnson (DRV-012)
Address: 88 S Main St, Akron, OH 44308
Accident Definition: This policy covers accidental bodily injury resulting directly and independently of all other causes from an accident occurring while the insured is performing duties as an owner-operator for Delta Advanced Trucking, Inc.
Coverage Territory: Coverage applies throughout the United States, Canada, and Mexico while on dispatch or traveling to/from dispatch locations.
Exclusions: This policy does not cover injuries resulting from: self-inflicted acts, war, nuclear incidents, or criminal acts by the insured.
Reporting Requirements:
Claims Administrator:
Travelers Claims Department
789 Insurance Plaza
Akron, OH 44308
Phone: (800) 555-7890
Fax: (800) 555-7891
Email: claims@travelers.com
Preferred Provider Network: Travelers has contracted with a national network of medical providers. Using in-network providers ensures direct billing and reduced out-of-pocket costs.
Emergency Care: In emergency situations, seek care at the nearest appropriate medical facility. Non-emergency care should be obtained from in-network providers when possible.
Provider Directory: Available online at www.travelers.com/providers or by calling (800) 555-7892.
Modified Duty: When medically appropriate, the insured may return to work with modified duties. Disability benefits continue if modified duty results in reduced earnings.
Rehabilitation Services: Coverage includes physical therapy, occupational therapy, and vocational rehabilitation services when prescribed by a treating physician.
Case Management: Travelers provides case management services to coordinate medical care and facilitate return to work.
Annual Premium: $3,600
Payment Schedule: Quarterly ($900 per quarter)
Next Payment Due: January 15, 2026
Payment Method: Automatic deduction from settlement payments
Policy Holder: Robert Johnson
Driver ID: DRV-012
Phone: 618-623-9317
Email: robert.johnson@boftransport.com
Emergency Contact: Robert — emergency contact - 555-0112
Delta Advanced Trucking, Inc. Safety Department:
Phone: (330) 555-0101
Email: safety@boftransport.com
Available 24/7 for accident reporting
Travelers Customer Service:
Phone: (800) 555-7890
Website: www.travelers.com
Mobile App: Travelers Mobile (available for iOS and Android)
This document serves as a certificate of coverage for the occupational accident policy described herein. This is not a contract of insurance. For complete terms and conditions, please refer to the actual policy document. Coverage is subject to the terms, conditions, and exclusions of the policy.