Request Contact Information Change

Form Instructions

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

MCIT Contact Designation Definitions

Click the term below to see a list of functions and responsibilities for each contact designation.

MCIT Primary Contact

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 retain 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 coordinate) the annual Workers’ Compensation Payroll Audit
  • Completes (or coordinate) the annual Risk Assessment
  • Completes (or coordinate) the annual Workers’ Compensation Payroll Estimate
  • Participates in MCIT’s annual Property and Liability Coverage Review
  • 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 communicate information about the program to member employees

Workers' Compensation Contact for MCIT

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

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

Property/Casualty Contact for MCIT

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, cyber and data compromise) 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 assist with discovery for litigated claims
  • Receives notifications of settlement conferences and trials for litigated claims
  • Coordinates payment of deductibles

Dividend Contact for MCIT

Receives notice of a MCIT dividend when declared.

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.