Office of Risk Management

Claims

Claims Supervisor - Jared Wise 814-863-5539

Athletic Injury Report - only for student athletes competing at Division 1, 3 or PSUAC levels, no IM or Club Sports.
Support Document Submission (Access only) To submit invoices and sensitive medical information.
Affidavit of No Insurance (18 and over) - This form should be completed by the student athlete who claims to have no available health insurance. The affidavit is a legal document and therefore must be notarized and returned tot he Athletic Director.
Affidavit of No Insurance (18 and under) - This form should be completed by the parent or legal guardian if the student athlete has no available health insurance. The affidavit is a legal document and therefore must be notarized and returned tot he Athletic Director.
Letter to Health Provider - Guidelines for health providers for bill payment for student athlete without health insurance.
Student Athlete Information Brochure - Contact jhw39@psu.edu for this document.

Vehicle Accident Report - This report must be submitted to the Risk Management Office no matter how minor the accident or if there was no damage at all. The Driver is responsible for completing the form. If the accident is alleged to be the result of a "Hit and Run", the police must be contacted.
Auto Physical Damage Workflow Guidelines- will provide how your particular damage assessment will be handled.

Extension Volunteer Incident Report and Reporting Instructions (pdf) - This form is to be utilized for the reporting of all incidents involving but not limited to 4H, Master Gardnerer, Military Youth Program, Strong Women Program to name a few.
4-H Residential Camps - Incident reporting same as Extension Volunteer Incident Reporting.
4-H Contacts and Responsibilities - Who to contact on related topics.

Audio Presentation - Familiarize yourself under what circumstances an Incident Form should be completed and filed with the Risk Management Office. Listen to the Adobe Connect recording.
Incident Form - in the event of an incident or accident possible resulting in an injury or damage to property to others including students, visitors and guests, the Risk Management Office requires the completion of the Incident Form.

Property Claim Reporting Tutorial - This presentation provides an overview to the property loss process including defining roles and setting expectations for those areas submitting a loss.
Property Loss/Claim - Expenses > $25,000 - Familiarize yourself with the financial process associated with the property claim process.
Property Loss Report - This form must be completed and sent to the Risk Management Office regardless if the loss may not exceed the deductible.
Inventory Worksheet – Utilize this worksheet to capture University owned or leased contents damaged or destroyed during a loss. This includes but not limited to: furniture, computers, equipment, instruments and other miscellaneous items. Personal property of others should complete an Incident Form.
Property Loss Worksheet - This worksheet must be completed and submitted to Risk Management along with all support documentation in order for the claim to be reviewed and approved by the University’s insurance company. Failure to complete this process in a timely fashion will financially impact the unit as all expenditures in the Special Budget will be returned to the unit.