If you need assistance entering a claim please call the Insurance Office at 727-374-0222.

Quick Reference Insurance Guide Last modified August 11, 2022

Workers’ Compensation

Commercial Risk Management (CRM) is our administrator for our employee accidents/injuries. 

THE SEVEN STEPS TO CARE OF AN INJURED EMPLOYEE:

  1. Give initial first aid treatment on site.  If no additional treatment is needed, report the claim to CRM (see step 4).
  2. If additional treatment is needed, send the employee to one of the listed Emergency Treatment Centers.
  3. Give the employee the following forms:
  4. If the accident/injury has not been reported to CRM do so now by completing the Workers Comp Report of Injury Form. All highlighted boxes must be completed on the form.
  5. Email the completed form to Commercial Risk Management at: NOI@crm-su.com
  6. Notify the DOSP Insurance & Risk Management Office by emailing form to: vcb@dops.org or fax: 727-374-0214
  7. Follow up by completing the following forms to prevent future accidents:

8. Email above 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.

  1. Complete the Liability Accident Report Form. Please complete all fields.
  2. Email completed form to Catholic Mutual Group (CMG) at: reportaclaim@catholicmutual.org
    • Include any pictures of the accident area and damage occurred when submitting the form.
  3. Notify the DOSP Insurance & Risk Management Office by emailing form to; vcb@dosp.org or fax 727-374-0214
  4. 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.

Property claims are reported by completing the Property Damage Claim Form

  1. Complete the Property Damage Claim Form. Please complete all fields.
  2. Email completed form to Catholic Mutual Group (CMG) at: reportaclaim@catholicmutual.org
    • Include any pictures of the accident area and damage occurred when submitting the form.
  3. Notify the DOSP Insurance & Risk Management Office by emailing form to; vcb@dosp.org or fax 727-374-0214
  4. 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.

To report an auto claim:

  1. Complete Auto Loss Report Form
  2. Once form is completed email to Catholic Mutual Group (CMG) at: reportaclaim@catholicmutual.org
    • Include any pictures of the accident area and damage occurred when submitting form.
  3. Notify the DOSP Insurance & Risk Management Office by emailing form to: vcb@dosp.org or fax 727-374-0214
  4. All Claims should be reported within 48 hours of occurrence.

Volunteer Accidents

 Accidents are administered though the Insurance Office. Accidents should be reported within 24-48 hours of the accident.

Step by step instructions for reporting Volunteer accidents:

  1. Complete the Liability Accident Report Form . Please complete all fields.
    • Note at the bottom of the form it is a Volunteer accident, list ministry volunteering for at the time of the accident.
  2. Submit the  completed form to the DOSP Insurance & Risk Management Office by emailing form to: vcb@dosp.org or fax 727-374-0214
  3. Include any pictures of the accident area and damage occurred when submitting the form.
  4. 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.

To Report a Student Accident:  

(1) Reporting steps to be completed by the school.

  • The school completes the Student Accident Form; See sample form listed below.
    • Section I – Complete in its entirety.  Please do not leave any blank information.
    • Section II –Parent Information – name, address, phone number and email address.
  • The Principal or Asst. Principal signs as the school administrator.
  • Email the form directly to the insurance carrier; K & K Ins. at: kk.PAClaims@kandkinsurance.com  
  • Copy the Insurance & Risk Management Office: vcb@dosp.org on the reporting email
  • 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. 

(2) 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 Section 2 of the Student Accident Claim Form
  2. Sign and date at the bottom of Section 2 of the form.
  3. Submit the following directly to K&K Insurance:
    • the 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.

Claim Forms – Benefit Outline