Claim Reporting Instructions

							                                                                                RISK MANAGEMENT
                                                                          CLAIM REPORTING INSTRUCTIONS

HOW DO I REPORT AN ACCIDENT


Type:                                 Student                                       Employee                            Automobile                 Property             General Liability
                                                                                  (Worker's Comp)

First                                                                   Ensure the safety and well-being of the injured person (people)

Next               Complete incident report to be given to parents                                Perform Drug Test


                                                      Regardless of type of claim, immediately complete an incident/accident investigation report
                                                              Get written statements from all witnesses -- have them signed and dated

Report Claim:      Notify DM & HR/Risk Management                    Regardless of severity of                              Report claim to District Manager and/or Scott Cotter
                                                                     injury, immediately notify                       a decision will be made by them to determine IF should file with:
                   If medical treatment is
                   required,                                         HR/Risk Management                           Peggy Whiten              Peggy Whiten             Peggy Whiten
                   FAX FORM - 30 DAY FILING LIMIT                    (706) 562-8600 x 7012                        JSmith Lanier             JSmith Lanier            JSmith Lanier
                   Administrative Concepts, Inc.                     (706) 888-8145                               1-800-226-4518 x 512      1-800-226-4518 x 512     1-800-226-4518 x 512
                   Phone - (888) 293-9229                                                                         706-576-3512              706-576-3512             706-576-3512
                   Fax Form - (610) 293-9299                         Review and complete Information For          after hours               after hours              after hours
                   994 Old Eagle School Rd, STE 1005                 Injuried Employee form with                  Markel Ins. Co.           Markel Ins. Co.          Markel Ins. Co.
                   Wayne, PA 19087-1802                              management and employee                      1-800-362-7535 x 6944     1-800-362-7535 x 6944    1-800-362-7535 x 6944

Notify Corporate                       Fax copy of claim form and copy of investigation report, and/or send email to DM & HR/Risk Management (706) 562-0314

Follow-up                Send standard itemized claim forms (UB-92 for hospital or HCFA-1500 for                            Maintain communication with District Manager/Scott
                   all other services along with benefit statements to                                                   or HR/Risk Management and follow instructions provided
                   Administrative Concepts, Inc. -- keep copies for your files.
                   Statements will not work. You MUST have ITEMIZED CLAIM FORMS!!

FYI                Insurance plan is secondary to any health                 $2500 deductible per injury          $1,000 deductible for     $5,000 deductible           $5,000 Per Claim
                   insurance parents have except for                                                              repairs to our vehicles   5% Value of bldg         Bodily Injury & Property
                   government plans (Tricare, Medicaid,                                                           when we are at fault         - hurricane           Damage
                   etc.).                                                                                                                   FL and various coastal
                   Parents should not incur any cost.                                                                                       properties, NC, 2%VA