NMPSIA Information and Claim Forms

New Mexico Public Schools Insurance Authority Information and Claim forms:

Vehicle Accident Report Form:

◇               This form is for District Vehicles {Bus, Car, Expedition, Truck, etc.) only.

◇               You must complete all information, make sure you describe damage and take pictures, always call police department and get police report done at time
                  of accident no matter how minor.

◇               Send the completed incident report along with pictures to Michell Aragon at Central Office within 24 to 48 hours.

 

Accident Report - General/Products Liability:

◇                This form is for District employees that damage other non-district vehicles or persons with weed eaters, mowers, etc.

◇               You must complete all information, make sure you describe damage and take pictures, always call police department and get police report done at time
                  of accident no matter how minor.

◇               Send the completed incident report along with pictures to Michell Aragon at Central Office within 24-48 hours.

 

Windshield only:

◇               This form is for District Vehicles {Bus, Car, Expedition, Truck, etc.) only.

◇               You must complete all information, make sure you describe how windshield was broken and take pictures.

◇               Send the completed incident report along with pictures and 3 price quotes of windshield to Michell Aragon at Central Office within 24-48 hours.

 

In Case of Serious Injuries- Student Incident Rpeort:

◇               This form is for Students Only whom received injuries during school.

◇                You must complete all information, make sure you take pictures if possible and call police department if necessary.

◇               Send the completed incident report along with pictures to Michell Aragon at Central Office within 24-48 hours.


Note: Confidential, This report is not to be released to parents and/or Students.


Loss Report, Property:

◇                This form is for school vandalism, theft, burglary, and employee dishonesty. Also, Boiler & Machinery loss.

◇               You must complete all information, make sure you take pictures if possible and call the police department.

◇               Send the completed incident form along with pictures to Michell Aragon within 24-48 hours.

These forms are available for download on the Cardinal website under Resources, go to Insurance Authority, and then click on forms.

CONFIDENTIAL, THESE REPORTS ARE NOT TO BE RELEASED TO PARENTS AND/OR STUDENTS.



ANY STAFF MEMBERS WHOM RECEIVED INJURIES DURING WORK MUST CONTACT 

MARIE KAVANAUGH AT CENTRAL OFFICE FOR WORKERS COMP FORM

FORMS-