File a Claim

File your claim in whichever way is easiest for you - online, email, phone or fax.

Online - Simply complete the claim submission form below.

Phone - Call 800.435.1127

Email - Email [email protected] and include as much information as possible in the body of your email.  The below form may serve as a guide for the kind of information we will need from you.  

Fax - Send your claim to 866.275.6320. Be sure to include as much information as possible.

Policy Details

Your Injured Worker


About Your Claim

Medical Treatment


Additional Information



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