2013 - 4th Quarter

New Claim Forms/How to Report a Claim

By JoAnne Flowers, Assistant Director for Risk & Insurance Management

The forms for filing claims have been converted to Excel format to simplify the process. The Excel option allows each user to fill out the form manually or electronically. If the form is completed electronically the user can save and/or email it to their appropriate campus contact within 24 hours after the accident or incident occurred. 

The First Report of Injury (UM WC-1) form has two tabs, one is the claim form that should be completed by the supervisor and page two is the information on where to direct employees for treatment. The Auto claim form (Vehicle accident report UM-5) is a two tabbed form. Please be sure to complete both page 1 and page 2. General liability claims are made by completing the “Student or General Public Injury and Property Damage Report” (Form UM-200).

In order to receive benefits under Workers’ Compensation, an employee must report the injury to their department immediately after it occurs. The department must report all injuries to the Worker’s Compensation Coordinator on a Report of Injury Form within 24 hours of the injury. The Report of Injury Form may then be mailed, faxed, or e-mailed to the appropriate Workers’ Compensation Coordinator.

The Automobile Liability Program provides coverage for bodily injury or property damage liability arising out of the operation of use of university-owned or operated vehicles. All university officers, agents, employees, authorized volunteers and authorized students can be covered under this program. The Comprehensive and Collision Program is a voluntary program that departments elect to participate. This program provides coverage for damage resulting from comprehensive (fire, wind, theft, etc.) and collision exposures on vehicles owned or leased by the university. If you drive a university vehicle, download your own innovative wallet guide to print and take with you (print with the double sided option).

General Liability provides coverage for bodily injury or property damage liability arising from ownership or use of buildings or premises and/or legal liability arising from university operations. This coverage can also extend to contractual liability, which means that it protects the University if involved in some types of contracts, for example, a building lease; some license agreements; an elevator maintenance agreement etc.

Examples include: 

  • Visitor falls on campus property due to a known dangerous condition of our property
  • Lawn equipment or debris damages parked vehicles


If you have any questions about the forms or University insurance, please contact you campus coordinator, refer to our website or contact us at (573) 882-8100.

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