Welcome to the Student Insurance Page at MSJC. Here you will find information and forms that will be necessary to read and fill out in the event of a Student Injury. In the event of an emergency, PLEASE CALL 9-1-1 to ensure that the Student is properly treated and refer to the “Student Injury Process” link. If otherwise or after the emergency has been dealt with, each of these links must be completed and examined to ensure proper treatment and compensation of the Student. Both the Student and the Teacher/Supervisor must be responsible for the completion of their respective forms and to make sure they are returned to the proper source. For any questions, please contact the Risk Department at (951) 487-3190.
Students: Please observe and fill out these forms for your Teacher/Supervisor.
Student Injury Claim Instructions for Students and Athletes
Claim Verification Form
SAIN (Student and Athlete Insurance Network)
Teachers/Supervisors: Please fill out this form and return to proper source on the back of the form.
Incident Report Form
Additional Resources and Information for both Students and Teachers/Supervisors can be found here:
Student Injury Process
2013-14 Information Bulletin
2014-15 Information Bulletin
Notice of Privacy
Online Claim & HIPAA Filing Instructions
Claim & HIPAA Filing Instructions
Definition of Expanded Benefit