Tropical Storm Chantal:
If you're in the storm's expected path, take these last-minute safety steps.
Prepare now.
FILING A CLAIM
Online, by phone or by email: File your claim, your way.
Expect a streamlined, efficient and user-friendly experience when you report your claim online.
Speak directly to a member of our team. Give us a call to put your claim in motion.
Review your options below for reporting a claim by email.
Quickly and easily access the required forms for a variety of claim types.
For incidents of property loss, automobile accidents and more, download the required claims forms here.
For damage to any of your property except vehicles.
For injury or property damage to others.
For injury or damage caused in an auto accident.
Depending on your organization’s location, you may need to file state-specific forms for workers’ compensation claims. Browse our forms by state and download those that are right for you.
NEW! DD-1 Form - New York Direct Deposit Requirements/Form
To receive your payment via electronic fund transfer, please complete and return the Direct Deposit Authorization form. If you choose to split your benefits between accounts, you must complete a separate form for each account you would like your benefits distributed to and include the amount to be placed in each account.
Once your request has been received, it may take up to three weeks to process. If additional information is needed your adjuster will contact you. The forms, or any claim documentation, can be sent with a clearly noted claim number via fax, email or mail.
We've partnered with Anthem to provide access to an extensive medical provider network (MPN). This MPN includes physicians who understand workers' compensation requirements and are experienced in providing expert care for injured employees.
Learn MoreQuickly and easily submit forms for new or old claims by emailing us at the appropriate address below.
