If you need assistance entering a claim, please call the Insurance Office: 727-374-0222
Workers’ Compensation
Commercial Risk Management (CRM) is our administrator for our employee accidents/injuries.
7 STEPS TO CARE OF AN INJURED EMPLOYEE:
1. PROVIDE FIRST-AID
Give initial first-aid treatment on site.
If no additional treatment is needed, report the claim to CRM (see step 4).
2. SEND EMPLOYEE TO TREATMENT
If additional treatment is needed, send the employee to one of the listed Emergency Treatment Centers.
3. EMPLOYEE FILLS OUT FORMS
Give the employee the following forms:
- To authorize treatment and coordinate the billing information:
- To authorize Prescriptions that are ordered during the first initial visit.
4. REPORT TO CRM
If the accident/injury has not been reported to CRM do so by completing the Workers Comp Report of Injury Form.
- Workers Comp Report of Injury Form
- Note: All highlighted boxes must be completed on the form.
5. EMAIL WORKERS COMP FORM
Email the completed Workers Comp Report of Injury Form to CRM.
- Email: NOI@crm-su.com
6. NOTIFY THE DIOCESE
Notify the DOSP Insurance & Risk Management Office by emailing or faxing the form.
- Email: vcb@dosp.org
- Fax: 727-374-0214
7. COMPLETE ADDITIONAL FORMS
Follow up by completing the following forms to prevent future accidents. Email the completed forms to: vcb@dosp.org
General Liability Claim
General liability claims are accidents that occur to non-employees on our property. Even though not all accidents may be covered under our liability policy they should be reported to Catholic Mutual Group (CMG) our claims administrator.
All claims should be reported within 24-48 hours of the accident.
4 STEPS TO REPORT A GENERAL LIABILITY CLAIM:
1. COMPLETE THE FORM
Complete all fields of the Liability Accident Report Form.
2. EMAIL THE FORM
Email completed form to Catholic Mutual Group (CMG). Include any pictures of the accident area and damage occurred when submitting the form.
3. NOTIFY THE DIOCESE
Notify the DOSP Insurance & Risk Management Office by emailing or faxing the form.
- Email: vcb@dosp.org
- Fax: 727-374-0214
4. REPORT WITHIN 48 HOURS
All claims should be reported within 48 hours of occurrence.
Property Claims
Property claims are administered by Catholic Mutual Group (CMG). Claims should be reported within 24-48 hours of the incident.
4 STEPS TO REPORT A PROPERTY CLAIM:
1. COMPLETE THE FORM
Complete all fields of the Property Damage Claim Form.
2. EMAIL THE FORM
Email completed form to Catholic Mutual Group (CMG). Include any pictures of the accident area and damage occurred when submitting the form.
3. NOTIFY THE DIOCESE
Notify the DOSP Insurance & Risk Management Office by emailing or faxing the form.
- Email: vcb@dosp.org
- Fax: 727-374-0214
4. REPORT WITHIN 48 HOURS
All claims should be reported within 48 hours of occurrence.
Auto Claims
Auto Claims are administered by Catholic Mutual Group (CMG). Claims should be reported within 24-48 hours of the accident.
4 STEPS TO REPORT AN AUTO CLAIM:
1. COMPLETE THE FORM
Complete all fields of the Auto Loss Report Form.
2. EMAIL THE FORM
Email completed form to Catholic Mutual Group (CMG). Include any pictures of the accident area and damage occurred when submitting the form.
3. NOTIFY THE DIOCESE
Notify the DOSP Insurance & Risk Management Office by emailing or faxing the form.
- Email: vcb@dosp.org
- Fax: 727-374-0214
4. REPORT WITHIN 48 HOURS
All claims should be reported within 48 hours of occurrence.
Volunteer Accidents
Accidents are administered though the Insurance & Risk Management Office. Accidents should be reported within 24-48 hours of the accident.
3 STEPS TO REPORT A VOLUNTEER ACCIDENT:
1. COMPLETE THE FORM
Complete all fields of the Liability Accident Report Form.
- Liability Accident Report Form
- Please make a note at the bottom of the form that it is a volunteer accident, list ministry volunteering for at the time of the accident.
2. NOTIFY THE DIOCESE
Submit the completed form to the DOSP Insurance & Risk Management Office by emailing or faxing it. Include any pictures of the accident area and damage occurred when submitting the form.
- Email: vcb@dosp.org
- Fax: 727-374-0214
4. REPORT WITHIN 48 HOURS
All claims should be reported within 48 hours of occurrence.
Student Accidents
Our Student Accident Insurance Provider is K&K Insurance. This excess policy is designed to supplement the families own private health insurance.
REPORTING STEPS TO BE COMPLETED BY THE SCHOOL:
1. SCHOOL COMPLETES THE FORM
The school completes the Student Accident Form. See a sample form below.
- Student Accident Form
- Section I – Complete in its entirety. Please do not leave any blank information.
- Section II – Parents complete. – name, address, phone number, and email.
- SAMPLE Student Accident Form
2. SCHOOL ADMINISTRATOR SIGNS
The Principal or Asst. Principal signs as the school administrator.
3. EMAIL THE FORM
Email the form directly to the insurance carrier, K&K Insurance, and copy the diocese.
4. NOTIFY THE DIOCESE
Copy the Insurance & Risk Management Office on the reporting email.
- Email: vcb@dosp.org
5. SAVE A COPY
The school should keep a copy of the form on file for future reference as needed.
- Make a copy of the claim form to be given to the parents.
REPORTING STEPS TO BE COMPLETED BY THE PARENTS:
Claim Submission steps to be completed by the parents for reimbursement of out of excess expenses. Note: Student Accident Insurance is an Excess Plan – Eligible covered expenses will be determined after benefits have been paid by other valid private insurance.
1. PARENTS COMPLETE FORM
The parents complete Section II of the Student Accident Form found above.
2. PARENTS SIGNS
The Principal or Asst. Parents sign and date at the bottom of Section II.
3. EMAIL THE FORM
Email the following directly to the insurance carrier, K&K Insurance.
Email: kk.PAClaims@kandkinsurance.com
- Claim form
- Itemized bills
- Explanation of Benefits (EOB) from their insurance carrier
- Note: Medical providers may bill K&K Insurance Group directly to the address on the claim form.