Claims Forms

Our forms are available as both PDF and MS Word® documents. PDF requires the free Adobe Acrobat® Reader, which you may download from Adobe's website. Be sure to include key information when completing your forms.

MS Word^® format	PDF format
1st Loss Report - all states except California (.doc)	1st Loss Report - all states except California (.pdf)
1st Loss Report - California only (.doc)	1st Loss Report - California only (.pdf)
Statement of Drivers - all states except California (.doc)	Statement of Drivers - all states except California (.pdf)
Statement of Drivers - California only (.doc)	Statement of Drivers - California only (.pdf)
State Fraud Warnings - Workers Compensation (.doc)	State Fraud Warnings - Workers Compensation (.pdf)
State Fraud Warnings (.doc)	State Fraud Warnings (.pdf)
FAX Cover Sheet (.doc)	FAX Cover Sheet (.pdf)

A loss should be reported ASAP to our Claims Intake Unit via fax, e-mail or by phone. Timely reporting of accidents is necessary to protect your interests and to preserve key information needed by your claims adjuster to conduct a good investigation.

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