Fill out the form below and click submit. You will receive a claim acknowledgement when the claim is set up and assigned to an adjuster.
Submit a Claim for Workers Comp
Choose One of Four ways to submit a claim
1. Click Here to submit a claim via your own email program.
If you have a completed Loss Form, you can send it to our Fax Line:
If you have a completed Loss Form ready to submit, you may upload it here and send it without filling out the rest of the form.