Request Contact Information Change

MCIT member organizations that need to update the contact information for key personnel with MCIT should complete this form. MCIT staff will contact the member to verify the requested change.

MCIT Contact Designation Definitions

A gatekeeper and liaison between the member’s operations staff and board, and MCIT. The duties of the primary contact are assigned to one person who collects and distributes important MCIT information regarding program administration, communications, and loss control and risk management efforts.

The key functions expected of the primary contact include but are not limited to the following:

  • Serves as the point of contact for MCIT communications, including sharing the information with staff and the governing board
  • Ensures the timely payment of the organization’s annual contribution to MCIT
  • Receives and retains the annual MCIT Coverage Document
  • Ensures property/casualty claims contact maintains property, electronic data processing inventory and automobile schedules so they are current
  • Completes (or coordinates) the annual Workers’ Compensation Payroll Audit
  • Completes (or coordinates) the annual Risk Assessment
  • Completes (or coordinates) the annual Workers’ Compensation Payroll Estimate
  • Participates in MCIT’s annual Property and Liability Coverage Update
  • Serves as the point of contact for loss control and risk management issues unless this has been delegated to another individual
  • Serves as the point of contact for MCIT election and voting delegate information
  • Receives updates about the Employee Assistance Program and communicates information about the program to member employees

Routinely interacts with MCIT about workers’ compensation (employee work-related injury and illness) claims-related issues and:

  • Submits the claim/incident notice (First Report of Injury) to MCIT in a timely manner through the member portal
  • Receives confirmation of the claim once submitted
  • Trains supervisors and employees about the injury reporting process and their related responsibilities
  • Works with MCIT claims representatives to manage claims

Routinely interacts with MCIT about property and liability (casualty) claims-related issues and:

  • Coordinates the reporting of all property and liability claims (auto, property, inland marine, general liability, public employee liability, bond and cyber) through the MCIT website
  • Receives confirmation of all claims once submitted
  • Works with your staff to ensure the collection of data after a loss for prompt reporting
  • Works with the MCIT claims representatives to manage claims
  • Receives updates and assists with discovery for litigated claims
  • Receives notifications of settlement conferences and trials for litigated claims
  • Coordinates payment of deductibles

Receives notice of an MCIT dividend when declared.

Is the local expert about the Employee Assistance Program provided through MCIT and:

  • Routinely promotes the program to the organization’s employees
  • Answers employees’ questions about the program, including about eligibility, uses, services and program parameters
  • Receives reports about the organization’s utilization of the report
  • Receives updates and promotional information/materials about the program

Request MCIT Contact Information Change

  • 1. Complete all required fields marked with an asterisk.
    2. Complete only those fields for the contact that need to be changed.
    3. When all necessary fields are filled in, click Submit button.
  • MCIT CONTACT INFORMATION CHANGES
  • Choose all that apply. See above for MCIT contact designation definitions.
  • REQUESTER INFORMATION
    Complete the following fields with the contact information for the person submitting the form.