Student Report of Injury

Northwest University Student Accident Reporting Steps

NU has a new process for completing the Student Report of Injury. The Wellness Center is now the department housing all Student Report of Injury original forms (formerly housed by Student Development). The Wellness Center will distribute completed copies of the form to Student Development and Security when necessary.

What to do if a student is in an accident:

Note: if the student was injured while working as a student worker, complete the employee injury report and send it to HR.

Priority # 1: Care for the student (e.g. call 911 if necessary, take the student to the Wellness Center if open, administer first aid, etc.)

If the Wellness Center is open and the student does not need emergency services:

  • Take the student to the Wellness Center and the staff there will complete the Student Report of Injury form with the student and any witnesses.

If the Wellness Center is closed:

  • Complete Northwest University Student Report of Injury form and Northwest University Wellness Center Release of Information form (back of Injury Report form)
  • Complete the BMI Benefits Claim form (top says How to file a Claim)
    • University employee complete Part 1A and sign the bottom of Section 1
    • Student completes Parts 1B, Parent/Guardian Information, Section A, Section B, and signs the bottom as claimant
  • Make a copy of the BMI Benefits Claim form
    • Send the original Student Report of Injury and one copy of the BMI Benefits Claim form to the Wellness Center
    • Give the student the Student Insurance Accident Packet including the original BMI Claim form
  • Send the student to an urgent care clinic, emergency room, or primary care physician
    • Student should present his or her primary medical insurance card along with the “Provider Information form” (third page of the Student Insurance Accident Packet)
    • Payment should proceed through the primary medical insurance provider first
  • Student or guardian submits a claim
    • After the student or guardian receives the Explanation of Benefits (EOB) from the primary insurance provider copies should be mailed by the student or guardian to BMI Benefits.
      • BMI Benefits, PO Box 511, Matawan, NJ 07747
      • Or fax to 732-583-9610

Forms and Instructions: