Covid-19 Update: RPS Bollinger Specialty Group remains fully operational during this crisis. Our Customer Support Staff, Claims Department and New Business Team are here to answer questions. Connect with RPS Bollinger Specialty Group through your usual channels or through the "Contact Us" link options on this site. We wish you and your families good health during this difficult time, and a safe transition back to your workplaces and schools in the near future.

Hazlet Board of Education: Claim Forms


Quick Links:


Choose the appropriate claim form.

Questions about claims? Call us at 866-267-0092.


Claim Form
For injuries that occur during school sponsored activities.


For Schools: All schools


Voluntary Claim Form
For students who purchased the Voluntary Student Accident Plan.


For Schools: All schools



For students who purchased the individual dental accident plan.


For Schools: All schools


Athletic Claim Form
For injuries that occur during an interscholastic athletic team activity.


For Schools: All schools



Para los estudiantes que hayan adquirido el Plan de Accidentes Estudiante Voluntario.


For Schools: All schools