NCSBT Members

Automobile/Inland Marine Fund

The following forms should be used to notify NCSBT of automobile accidents or losses, inland marine losses, or vehicle schedule changes.

Automobile Loss Notice Form:  This form must be completed and submitted to NCSBT promptly following an automobile accident or loss, along with a written statement from the driver of the member vehicle describing the accident or loss and a copy of the police report and any complaint, petition or other pleading filed in court as a result of the accident or loss.

Vehicle Change Request Form:  This form must be completed to make an addition, deletion, or change to your vehicle schedule.

Inland Marine Loss Notice Form:  This form must be completed and submitted to NCSBT promptly, or in any event within fifteen (15) days of discovery of the loss.  Please also attach a copy of any incident report prepared, and a copy of the receipt, purchase order, or invoice for the covered property.

Inland Marine Change Request Form:  This form must be completed to make additions or deletions to your scheduled inland marine equipment as set forth on the form.

Temporary Employees and Independent Contractors Form: This form must be completed to make an addition, deletion, or change to your scheduled temporary employees or independent contractors.

Errors & Omissions/General Liability FundDrone Liability Coverage

The following form should be used to create or modify a member’s drone schedule on file with NCSBT.

Drone Liability Schedule Change Request

Errors & Omissions/General Liability Fund—Medical Payments Coverage

The following forms should be used when filing a claim or submitting information related to a claim under NCSBT’s no-fault medical expense coverage.

Medical Expense Certificate:  The Medical Expense Certificate, along with all requested documentation, must be completed and submitted within one year of an accidental injury.

Supplement to Medical Expense Certificate:  The Supplement to the Medical Expense Certificate, along with all requested documentation, may be completed and submitted within fourteen (14) months of an accidental injury.  It should only be used to supplement a previously completed Medical Expense Certificate that was submitted within within one year of an accidental injury.

Risk Management
 
Donna Lynch Litigation Counsel dlynch@ncsba.org 919.747.6685
Forrest Fallanca Assistant Litigation Counsel ffallanca@ncsba.org 919.747.6701
David Byrd Claims and Risk Services Consultant dbyrd@ncsba.org 919.747.6683
Christina Miller Data Analyst cmiller@ncsba.org 919.747.6687
Kelly Morgan Claims and Risk Management Specialist kmorgan@ncsba.org 919.747.6681
Melody Coons Litigation Assistant mcoons@ncsba.org 919.747.6684
Lee Adams Assistant ladams@ncsba.org 919.747.6707
Helen Gelb Assistant hgelb@ncsba.org 919.747.6712