General Liability Report Template

Note: if you are completing this form to submit a Student Medical Payment claim, please have the parent complete the Medical Payment Claim Form in the link below and upload it, along with copies of the medical bills and any other supporting information, with your submission of this online form.

Medical Payment Claim Form

General Liability


















































(will also receive copy of incident report)

If there are any questions, please contact your P/C Claim Representative at pcclaims@setseg.org, 800-292-5421 or by fax 517.482.0800

If submitted properly, a confirmation email will be sent to you with a reference ID number. It is important to keep that reference ID number in case you have questions.

Submit your form