Print Claim Forms
Property Loss Report
For damage to any of your property except vehicles.
Accident Report
For Injury or property damage to others that may have been caused by you or your organization.
Automobile Accident Report
For injury or damage caused in an auto accident.
Workers' Compensation (forms by state)
For injury to an employee.
For California customers only:
NEW! SB 1159 - California Workers’ Compensation Reporting Requirement for COVID-19 | Form Instructions
If you are notified of a Covid-19 diagnosis that is not alleged to be work related:
For each case, complete a separate SB 1159 form, attached, and send to Claimsintake@churchmutual.com.
If you are notified of a Covid-19 diagnosis that is alleged to be work relatedby the employee:
- 1. Complete SB 1159 form that is attached.
- 2. Complete Form 5020 — Employer's Report of Occupational Injury or Illness.
For each case, complete both forms and email to Claimsintake@churchmutaul.com
If you previously reported a Covid-19 claim, after July 5th, and the SB 1159 form has not been completed:
Complete the SB 1159 form and send to Claimssupportcompliance@churchmutual.com. Follow this process for each case of this type. Be sure to include the claim number on the SB 1159 form.
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