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Student Injury

Public Safety

Student Accident and Illness Plan

  • A claim for medical services must be completed and returned to the insurance company within 120 days of the injury or first date of illness.
  • Claim forms are available from the SMCC Student Enrollment Services (SES) office.
  • Complete the claimant’s portion of the form, present it to the doctor or hospital rendering service for diagnosis and itemized statement, and attach all itemized doctor and hospital bills.
  • Student Accident Insurance plan brochure.

Forward all completed claim forms to:

Personal Insurance Administrators Inc.
P.O. Box 6040
Agoura Hills, CA 91376-6040
Toll Free: 1.800.468.4343