Work Comp Loss History Survey

Our insurance company has asked us to gather information about previous WC claims from all schools who currently have coverage and are moving to the master policy. We regret the inconvenience.

You should be able to get your loss history as a report from your work comp insurance agent. Please upload that report below, even if it's an empty report.

If you haven't had coverage, please answer "No" to that question below, and we won't require any additional information.

Name *

First

Last Name *

Last

Email *

School Name

Did your school have Work Comp for 2022-2023 school year?

Yes

No

Information Requested

If your previous insurance company provides a loss run document, you can chose the first option and upload the file below.

OR

If they inform you by email that you have had no losses to date, you can chose the second option, then just forward that email to caleb@gospelpublishers.com

Please include the school name in any email. Thanks!

Options

Upload a Loss Report file below

I'll email the information to the address above

Please upload a Loss Report from your insurance company

Maximum file size: 130MB

Additional comments or suggestions

Previous Work Comp Info

Information Requested