Nursing Student Medical Claims

All claims must be submitted by the injured party directly to Bob McCloskey Insurance at the contact information below. If you utilize the Franciscan Treatment Center for treatment, please submit the claim form to them, as well.

For all questions regarding student injury policy in the School of Nursing and Health Professions please refer to the School of Nursing and Health Professions Injury Policy as listed in your student handbook or contact your respective Program Director or Department Chair(s).

Claim Information

1. To file a claim, please complete this Nursing Medical Claim Form. If seeking treatment at Franciscan Treatment Center, bring claim form to Franciscan Treatment Center (contact information and location below).
2. Submit claim form and any associated invoices, bills, HCFA 1500 or UB92 forms to Bob McCloskey Insurance Agency following treatment.

All Claims must be submitted 90 days or as soon as possible, or within 90 days of date of injury or first treatment for the injury. Claims reported after 1 year of injury will not be considered. (Medical bill, HCFA 1500 or UB92 should be used to submit expenses.)

Franciscan Treatment Center Information:

1199 Bush Street, Suite 160
San Francisco, CA 94109

Claims Contact: Gayle Chan-Lee, gayle.chan-lee@dignityhealth.org or (415) 353-6305

Bob McCloskey Insurance Agency Claims Reporting Information:

Bob McCloskey Insurance
P.O. Box 511
76 Main Street, Matawan, NJ 07747

Claims Email Address: donnap@bobmccloskey.com

Nationwide Toll Free Phone Number: 1 (800) 445-3126, x507

Customer Service Hours: 9 a.m.–5 p.m. (EST)