Student Accident / Injury Reporting Forms Flow Chart
Student Accident Report
- Complete for all injuries requiring medical attention other than minor cuts or bruises
- Completed by supervising staff member
- Copy for your accident files
- Forward original to Gallagher Bassett Services office
- This protects you and your (Arch) Diocese for potential liability/negligence claims
Student Assurance Services Claim Form
- Student accident medical policy provided by your (Arch) Diocese
- Covers out of pocket medical costs1 for injuries occurring during school sessions and school-sponsored activities
- Parent/guardian will request claim form to cover expenses
- Complete Part A from information contained in your copy of the Student Accident Report
- Provide claim form to parent/guardian
- Parent/guardian pursues claim with Student Assurance Services
As always, If you have any questions or concerns, please do not hesitate to call the Risk Management Department at (517) 372-9310 or 1-800-395-5565.
- Subject to terms and conditions of policy ⇧