Submit a Claim: Work Comp

Please Read Carefully
Review all steps before beginning.

1. Click HERE to launch a new window containing the Work Comp claims form.

2. Complete the form, be sure of all your answers before proceeding to step 3.

3. Print a copy of the form for your records by clicking the "Print Form" button.

4. Click "Submit by Email".

If you have a default email client on your computer (eg. Outlook, Thunderbird, etc.) a new email message will appear. Skip to step 7.
If you use web based email (eg. Yahoo!, Hotmail, GMail, etc.) and you do not have an email client on your computer, you will see the "Select Email Client" dialog. Proceed to step 5.

5. Select the "Other" option in the "Select Email Client" dialog. Click "OK".

6. In the "Sending the Data File" dialog, follow the steps carefully to save and attach the data file to a new email message. Don't forget to enter the correct email address in the "To:" field of your email message.

7. Do not alter any other parts of the message. Simply click send.

8. You may now close the form window.

^*Please be advised that policy coverages and changes can not be bound or made effective until they are received, reviewed & approved by a licensed agent, at which time you will be contacted via phone to confirm the coverage.