Student Accident Claims

Student Accident Report

1. Complete for all injuries requiring medical attention other than minor cuts or bruises
2. Completed by supervising staff member
3. Copy for your accident files
4. Forward original to Gallagher Bassett Services office
   • Either call it in to (833) MCC-LOSS (833-622-5677) or
   • Email it to MCCLoss@mvsc.com
5. This protects you and your (Arch) Diocese for potential liability/negligence claims

Student Assurance Services Claims Form

1. Student accident medical policy provided by your (Arch) Diocese
2. Covers out of pocket medical costs for injuries occurring during school sessions and school-sponsored activities
3. Parent/guardian will request claim form to cover expenses
4. Complete Part A from information contained in your copy of the Student Accident Report
5. Provide claim form to parent/guardian
6. 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 (800) 395-5565.