A-G Administrators is one of the largest student and athletic accident TPA’s in the country with state of the art claims reporting technology and capabilities.

To report claims, review the top right corner of the attached new claim form, A-G Administrators has an online portal for claim form and document submissions.

Any claims reporting questions can always be directed to First Agency as they will be able to help make sure everything is submitted correctly.

1. A fillable copy of the NEW PSIC student accident claim forms for the Base/Mandatory coverage are attached.

This new form is replacing the First Agency form, as of July 1, 2024. PLEASE DISCARD ANY FORMS YOU MAY HAVE THAT ARE NOT from A-G Administrators.

A few more details -

● District Staff (Nurse or Athletic Trainer) will fill out the first 3 sections of the form, sign the last page, and give the rest to the parent to complete.

● Make sure to include the letter to the parent when presenting them with the form (accident claim instructions).

● It is the parent's responsibility to file the form with A-G if they choose to make the claim.

● Please make a copy and send to the District Office before sending to the parent.

Reminder, DISCARD ALL PREVIOUS FORMS - THEY WILL NO LONGER BE UTILIZED. Any forms that you use as injury notifications to parents may still be used but do NOT work as claim forms and do NOT need to be sent to the District Office, please keep those in the student file at your building.

Please feel free to reach out if you have any questions!

Thank you,

Mandi Callaway | Executive Assistant to the Superintendent and Board of Education