PROCEDURE FOR REPORTING AN ACCIDENT OR INJURY

 Report the accident or injury to the MLC Nurse

  1. Pick up Church Mutual Insurance forms from the nurse
  2. Return the WHITE copy to the Nurse
  3. Send both YELLOW copies to Church Mutual Ins. Co. immediately
  4. File a claim with YOUR OWN insurance company
  5. After your insurance company has paid all that they will pay, send copies of the claim and payments made by your company to Church Mutual
  6. There may be a $100.00 balance to be paid by the student to the provider.

Church Mutual Insurance Company

PO Box 342

Merrill, WI  54452-0342

800-554-2642

Fax #  715-539-4651