Available Claim Forms
To submit a claim use one of the appropriate links below. If none are available for your particular claim, please contact us directly.
We hope you never have to file a claim, but if you do, you can count on our In-House Claim Support to help you settle your claim. Emily, our Claims Advocate, guides you through the claim process, submits your claim with the insurance company and follows through with you and the insurance company until the claim is settled. She is here for you to help make the process as simple and timely as possible… from start to finish.
If you have a claim to report, you can take advantage of the forms below to begin the process.
You may also contact Emily by phone 920.827.2288 or email firstname.lastname@example.org.
After completing the First Report of Injury Form, please save the form and send via email attachment to Emily at email@example.com.