Claims Pages
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Employer Occupational Injury And Disease Report (Spanish)

Basic reporting form used by an employer to record an employee's injury or illness on the job.
  PDF (50 KB) Forms Property & Casualty


Connecticut WC Forms

A collection of workers' compensation forms which are authorized to be used in the state of Connecticut.
  PDF (0 KB) Forms Property & Casualty

Parent/Guardian Release (Spanish)

This legal form for Parent/Guardian releases an insurer from any liability or indemnity claim for damages or injuries resulting from an accident involving a minor in exchange for a monetary settlement.
  PDF (85 KB) Forms Property & Casualty

Illinois WC Forms

A collection of workers' compensation forms which are authorized to be used in the state of Illinois.
  PDF (0 KB) Forms Property & Casualty


PIP Attending Physician's Report

The attending physician report form is used by an insurer to determine if a person is due benefits under personal injury protection (PIP) law.
  PDF (55 KB) Forms Property & Casualty

New Hampshire WC Forms

A collection of workers' compensation forms which are authorized to be used in the state of New Hampshire.
  PDF (0 KB) Forms Property & Casualty

Kansas WC Forms

A collection of workers' compensation forms which are authorized to be used in the state of Kansas.
  PDF (0 KB) Forms Property & Casualty

Notice Of Plate Glass Loss

The notice of plate glass loss details the circumstances and description of loss. Included is an estimate for lowest replacement cost by a glazier.
  PDF (35 KB) Forms Property & Casualty


Rhode Island WC Forms

A collection of workers' compensation forms which are authorized to be used in the state of Rhode Island.
  PDF (0 KB) Forms Property & Casualty

Guarantee Of Title (Spanish)

For a case involving a total loss or theft of a financed motor vehicle or boat, this is an agreement that the lien holder will provide a lien free Certificate of Title to the insurance company upon receipt of a claim payment.
  PDF (20 KB) Forms Property & Casualty

PIP Application - Florida No Fault (Spanish)

Application form for Florida personal injury protection (PIP) No Fault benefits.
  PDF (45 KB) Forms Property & Casualty