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Claims Reporting and Forms
GENERAL CLAIM INSTRUCTIONS
This information will help us to
report your claims in a timely and
thorough manner, and within the
statutory requirements. All claims
should be faxed,
emailed or called
in as soon as possible.
Our fax
number is 301-838-9095.
Our phone
number is 301-838-9400.
The email
address for reporting claims is
tbee@insassoc.com.
REPORTING
INFORMATION
A) Complete the
proper claim form and: |
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Downloadable Claims
Forms
To download a form
to your computer,
right-click the form
and select "Save
Target As..." |
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For Automobile
Claims:
1) If reported to
police, we need the
police report/case
number and which
police district
reported to.
2) If injuries, when
possible, should get
person's age, which
vehicle they were
in, what type of
injury and where
they were taken. If
accident resulted in
bodily injury to any
party involved,
immediately report
accident to police.
3) If your vehicle
is involved in an
accident with an
UNINSURED
MOTORIST
(This also includes
hit-and-run or
vehicle theft) you
must report the
accident to the
police. If police do
not want to make a
report, PLEASE READ
INSTRUCTIONS UNDER
ITEM C. |
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For Liability
Claims: |
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1) If a utility line
is damaged
underground, an
Underground Damage
Form must be
completed.
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B) All Workers’
Compensation claims are to
be reported directly to the
insurance company. See
additional instructions
regarding the reporting of
Workers’ Compensation claims
below. All other claims may
be called, faxed or
emailed in to our agency
for processing.
C)
Please report all thefts to
the police. If the police
will not take a report, get
the officer's name and
precinct, so we can show the
company you made an attempt
to file a report.
D) Please call us as
soon as you receive any
SUIT PAPERS. We
can give you the exact name
and address of the adjuster
who is handling the claim.
You should either fax or
email a copy of the suit
papers to us.
E) Please be sure to
let us know if you feel you
are not responsible for a
claim. We will then make the
insurance company aware and
claim will be investigated
more aggressively.
WORK-RELATED INJURY
REPORTING INSTRUCTIONS
All employee work-related
injuries must be reported
directly to the workers
compensation insurance
carrier via telephone as
soon as possible. Below is
all of the information
required to set up a claim
at the insurance carrier.
Please contact Insurance
Associates at
301-838-9400 to obtain
the appropriate claims
reporting telephone number
of your workers compensation
insurance carrier.
Company Information
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Account Number and
Location Code (if
applicable)
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Parent Company Name (or
Program Name)
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Policy Number
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Injured Worker
Information
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Name, Date of Birth,
Address, Phone Number
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Social Security Number
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Age, Gender
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Marital Status, Number
of Dependants
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Hire Date, Years in
Current Position
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Current Wage Information
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Details of Incident
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When was the accident
reported to you and by
whom (date, time)?
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Address where injury
occurred?
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Type of injury (burn,
cut, sprain, etc)?
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Exact body part injured?
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Cause of accident (slip
& fall, struck by
object, etc.)?
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Do you have any reason
to question this injury?
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What is the estimated
number of days the
employee will lose time
at work due to the
injury?
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What is the anticipated
date of return to work?
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Did anyone witness the
accident? If so, who?
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Where was the injured
employee treated (name,
address, phone number of
medical provider
facility)?
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IF YOU HAVE ANY QUESTIONS
REGARDING A CLAIM PLEASE
CALL US!
Trisha K. Bee
Claims Coordinator
301.315.6782 (direct)
tbee@insassoc.com |
