Student Request for Insurance Information

Research, Environmental Health and Safety   |   Approved June 2, 2020

Purpose

Requesting proof of insurance or claims history.

Applicability

Students working in clinical settings as part of their academic program requesting confirmation of professional liability coverage or insurance claims history. Please be advised that your request cannot be processed until you graduate. Requests made before your graduation date will be held until such time.

The Office of Environmental Health and Safety (EHS) details academic programs currently covered on their website.

Instructions

Requesting Proof of Insurance / Claims History:

1. All requests for proof of insurance and/or claims history require a form of request providing basic information, listed here, along with an enrollment verification from the Office of the Registrar.
2. It is preferred to use the University's form (link below)‌‌.
3. If the form provided by an employer or academic institution is used, the graduate must verify that the form includes all required information, and append additional pages as required if the form is not as comprehensive as the University’s form.
4. Forms must be signed by the graduate. If the name of the graduate is not the name that appears in current University records, evidence of change of name (e.g., copy of marriage license) must be provided.
5. Required information includes:
   1. Full name of the graduate (include maiden and/or married name).
   2. Current address, phone number, and email address.
   3. School and program attended, degree obtained, and years enrolled at school.
   4. Where information is to be sent, and whether the recipient will accept a facsimile or email. Information must be sent directly to the requesting employer or academic institution.
   5. Whether the graduate wishes to receive a copy of the mailing to the requesting employer or academic institution.
   6. Graduate’s statement that the University and the State of Maryland are authorized to release the information requested, and held harmless from any liability as a result of releasing the information.
   7. Enrollment verification from the Office of the Registrar.

Allied Health Program Graduates and Dental School Graduates

1. Complete the Request for Verification of UMB Student Professional Malpractice Coverage and/or Claims History Form (PDF) (Online Form) and fax request to EHS Risk Management at 410-706-8212 or email to EHSRiskManagement@umaryland.edu.
2. Complete Request for Enrollment Verification to be sent to EHS Risk Management. 714 W. Lombard Street, Baltimore, MD 21201.
3. EHS Risk Management will review for completeness after verification of enrollment is received.
   1. Release forms must be signed by graduates and must contain all requested information or they will be returned for completion.
4. EHS Risk Management will then forward the request to the appropriate State of Maryland office for further action.  The entire procedure can take up to 21 days.

Medical Students

1. Send the Request for Verification of Student Professional Malpractice Coverage to PhysicianUnderwriting@mmcip.umm.edu. Any questions should be referred to the Office of Risk Management, Maryland Medicine Comprehensive Insurance Program (MMCIP), 250 W. Pratt Street, Suite 1200, Baltimore, MD 21201, 410-328-4704.