The Northern Illinois Conference’s Property and Casualty program includes; providing claim advocacy for Property, Liability and Workers’ Compensation losses, calculation of the annual insurance allocation/premium and development of a safe environment for Conference churches, volunteers and visitors.
Dwayne Jackson, Director of Risk Management and Ministry Protection
2017 Insurance Summary & Claim Reporting Instructions
Note, effective January 1, 2017, all claims shall be reported by the church, camp or ministry directly to the insurance company listed.
Refer to the attached for a “Recap” of the insurance deductibles and the policy limits by line of coverage.
Certificate of Insurance Request Form
Please complete the Certificate of Request Form and forward to Dwayne Jackson, Risk Manager, at firstname.lastname@example.org. The requested Certificate will be issued within forty-eight (48) hours of receiving the request, Monday – Friday.
Sample Insurance Claim Forms
In preparation of reporting a loss to the insurance carrier the following sample insurance claim forms may be used as a guide to assemble information requested by the insurance carrier.
- Property – Worksheet For Property Telephone Reporting
- General Liability – General Liability Notice of Occurrence / Claim
- Auto Accident Form
- Workers’ Compensation – Form 45
Add/Delete Vehicle or Building
Please complete the Add/Delete Form in order to Add/Delete a vehicle or building.
Fax Cover Pages
Please complete the attached Fax Cover Page to submit information/documents to the Philadelphia Insurance Company (e.g. General Liability or Auto) or to Travelers Insurance (e.g. Property).
- Fax Cover Page – Philadelphia Insurance (General Liability or Auto)
- Fax Cover Page – Travelers Insurance (Property)