Student Accident Insurance: The Claims Process and Common Problems

If a student at your school becomes injured, it can be stressful and scary. After all, you care about your students, and you also feel responsible for keeping them safe on your school grounds.

So if you’re in that stressful situation, the last thing you want is to also have a student accident claims process that is slow, frustrating, and full of roadblocks.

At Berry Insurance, we work with several Massachusetts schools who have student accident insurance. That means we’ve seen our fair share of student accident insurance claims. Most times, they are seamless. Other times, they can become drawn-out, complex, and frustrating when not executed properly.

In this article, we will go over how the student accident claims process should work, and what you should do to avoid a complicated claim situation.

What is student accident insurance?

Before we get into the issues with the claims process of student accident insurance, let’s start with a brief overview of what the insurance actually does.

Student accident insurance is generally purchased by institutions with students, such as schools, and covers students (and their parents) from costs associated with becoming injured at school events. (It also can help prevent lawsuits from parents regarding student accidents.)

Student accident insurance is an “excess” policy, meaning it kicks in after another insurance pays first.

In this case, if a student is injured at a school event, their personal health insurance would pay first, then the student accident insurance would pay for any additional deductibles, copays, or any out-of-pocket expenses that would normally be left to the student or parent to pay. 

Having student accident insurance is not mandatory – it is simply a goodwill gesture, but it has also become common practice. In fact, most schools in Massachusetts have the coverage, including those that we serve.

How the student accident insurance claims process works:

If a student is injured, he or she would first get the medical treatment they need, and the medical provider would bill the primary insurance.

In an ideal situation, the school and family would then work together to complete the accident claim form which needs to get submitted to the student accident insurance administrator. The school would begin and sign the accident claim form, giving it to the parents to complete and submit to the school’s insurance.

The parents would then notify the medical provider that they have secondary insurance through the school, submit the insurance to the provider who will bill the student accident insurance after the primary coverage pays the claim.

Of course, if the parents receive a bill, they would work with the medical provider and the secondary insurance administrator to obtain the necessary documents which include the itemized bill and primary explanation of benefits (EOB) for processing of any balances under the school’s policy.

Common issues with student accident insurance claims:

While the claims process we outlined above is the ideal situation, it doesn’t always go quite that seamlessly.

Because the student accident claims process involves multiple parties, miscommunications and missteps do happen.

Usually, all the issues and roadblocks we see stem from the same scenario: parents forgetting to notify the school about the injury right away. 

Whether or not they know about student accident insurance, it is not uncommon that parents choose to not notify the school of their child’s injury because they plan on just taking care of it through their child’s health insurance. But here’s the thing: things don’t always go as planned and sometimes further down the line parents will realize they do actually need to use student accident insurance.

Take this scenario for instance: 

Little Johnny slips on a wet floor in the hallway at school and falls and breaks his arm. Johnny’s mother takes him to the doctor for treatment, the treatment is processed through Johnny’s health insurance, and both Johnny’s parents and the school think everything is all set.

…

Then the bill comes. Johnny’s parents have a high-deductible health insurance plan and are now stuck with an unexpected $5,000 out-of-pocket bill.

They become angry and decide to come after the school for the money. The school informs them they have student accident insurance that would cover this situation and can file a claim for them, but at that point they’re a little behind in the process, and things have already become a little contentious.

They file the claim, but it takes some time to be processed.

Meanwhile, Johnny’s parents keep getting called by the billing company and start getting collections notices. They keep calling the school, having angry discussions about when the claim will be paid.

Most of the frustration in this example could have been avoided if the school was prepared to file a claim sooner.

So to avoid these issues, we recommend that schools do the following:

Advertise the fact that you have student accident insurance: Many parents simply do not know that student accident insurance is an option if their child gets injured. They may just assume they have to pay for the injuries, but when they get a high bill and become frustrated, that’s when things get heated and they may try to come after the school with a lawsuit. Even though you can inform them about having student accident insurance, things may have already gotten heated by that point. All of these headaches and tensions can be avoided if parents are aware of the student accident program. 

Encourage parents and students to always report injuries: Even if parents know about the student accident insurance and don’t anticipate using it, they should still always report injuries. If something changes and they realize they will in fact need the student accident insurance, at least the school has all the details and is better prepared to file a claim and the process isn’t as held up.

Protect your students, prepare their parents

Sometimes, having student accident insurance isn’t enough. 

You also need to fully understand how the claims process works and make sure parents are also educated on it, so you can avoid stressful situations if you do ever need to file a claim.

But wait. There’s more. You should also know about what situations student accident insurance covers and make sure you have the right customized protection for your school. Student accident insurance is complex and not all policies are the same. Some only cover sports-related activities, while others cover all school related events.

To learn more about student accident insurance and what it covers, check out this article: What is Student Accident Insurance and Does Our School Need it?