Request for Confirmation of Professional Liability (Malpractice) Coverage
Claims History Allied Health, Dental, and Medical Students

The University of Maryland Baltimore maintains a number of different programs to provide professional liability insurance coverage for its students while in clinical settings  as part of their academic programs.  As a result, the method for future employers or academic institutions to verify coverage and learn of claims histories for former University students varies depending on a former student’s school and specific academic program.

Please be advised that your request cannot be processed until you graduate. Requests made before your graduation date will be held until such time.

The University’s insurance program provides professional liability coverage for the following students:

      Allied Health Students IN THESE PROGRAMS:

School of Medicine:

  • Human Genetics Counseling
  • Medical Research and Technology
  • Pathology – Student
  • Physical Therapy and Rehabilitation Science  

School of Nursing

  • Undergraduate and Graduate  

School of Pharmacy

  • Pharm.D.

School of Social Work

  • Undergraduate and Graduate  

Dental School Students in these programs

  • D.D.S. (Dentists)
  • B.S. Dental Hygiene (Dental Hygienists)

Medical Students in the M.D. Program.

Procedure for Requesting Proof of Insurance / Claims History:

All requests for proof of insurance and/or claims history require a form of request providing basic information, listed here.  It is preferred to use the University’s form.  If the form provided by an employer or academic institution is used, the graduate must verify that the form includes all required information, and append additional pages as required if the form is not as comprehensive as the University’s form.

Forms must be signed by the graduate.  If the name of the graduate is not the name that appears in current University records, evidence of change of name (e.g., copy of marriage license) must be provided. 

The required information is:

Full name of the graduate (include maiden and/or married name).
UM Student ID number
Date of birth
Current address, phone number, and email address.
School and program attended, degree obtained, and years enrolled at school.

Where information is to be mailed, and whether the recipient will accept a facsimile or e-mail. Information must be sent directly to the requesting employer or academic institution. 

Whether the graduate wishes to receive a copy of the mailing to the requesting employer or academic institution.
Graduate’s statement that the University and the State of Maryland are authorized to release the information requested, and held harmless from any liability as a result of releasing the information.

Procedure for Allied Health Program Graduates and Dental School Graduates

The employer or academic / research institution must request the information in writing and submit a request signed by the graduate. 

The request should be faxed to EHS at the address below. EHS will review the request for completeness and obtain an enrollment verification from the appropriate school or the student/graduate may request an enrollment verification from the Office of the Registrar and ask that a copy be sent to EHS c/o Angela Boxley, 714 W. Lombard Street, Baltimore, MD 21201. After verification of enrollment, the request will be sent to the appropriate State of Maryland office for further action.  The entire procedure can take up to 21 days.  It takes longer if paperwork is incomplete or incorrect.

Release forms must be signed by graduates and must contain all requested information or they will be returned for completion.

Medical Students

The employer or academic / research institution must request the information in writing and submit a form signed by the graduate. The form should be faxed to the attention of Pat Zichos at Maryland Medicine Comprehensive Insurance Program (MMCIP), Suite 200, University Square Building, 11 S. Paca Street, Baltimore, Maryland 21201.   Contact information for MMCIP for follow up is NOT the information below fo rEHS.  The MMCIP contact information is also stated below.

Contact Information:

EHS
University of Maryland Baltimore
714 West Lombard Street
Baltimore, Maryland 21201
FAX : (410)  706-8212

Angela Boxley
aboxley@af.umaryland.edu
(410) 706 - 3221

Office of Risk Management (FOR MEDICAL STUDENTS ONLY)
Maryland Medicine Comprehensive Insurance Program (MMCIP)
250 W. Pratt Street, Suite 1200
Baltimore, Maryland  21201
FAX: (410) 328-3391

Pat Zichos
pzichos@mmcip.umm.edu
(410) 328-3931