Maricopa Emergency Management System Alert

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Student Injury

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.

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