Complete the form below to change the agent with whom you are working with on your workers compensation assigned risk policy. Additional information may be required before we can process your requested change. The information you provide will only be used to help us serve you better. It will not be sold or distributed. Please see our
Privacy Statement for more details.
Is this form being submitted by the Agent or the Policyholder?
Report a Claim
Property & Casualty Claims
Call us any time 24/7 to report a claim:
Assigned Risk Services
Contact assigned risk services through the forms listed below.
Need something not listed above?
Contact usSend us questions / comments