To submit a new claim, follow these steps:

• Print this page (optional).
• Enter FIRST SIX NUMERIC DIGITS of your policy number.
• Correctly complete the Captcha.
• Click below on Proceed to claim entry
• On the next page, enter the date of injury.
• Click NEXT
• Answer the questions on each screen. Click NEXT to move from screen to screen.
• Required questions are marked with an asterisk and must be answered before moving to the next screen.
• On the confirmation page, click the link in the middle of the page to print a copy of the first report. The first report of injury will display. Print/Save a copy and note the loss number in the upper right corner of the form.