Report Other Exposures​

Please complete the form below regarding your workers compensation assigned risk policy. 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.

Additional information may be required before additional coverage may be added. To add an additional state to your policy, underwriting approval and pre-payment is required.

Report Other Exposures

Is this form being submitted by the Agent or the Policyholder?

Select Request Type

Indicates a required field

​Report a Claim

​Property & Casualty Claims

Call us any time 24/7 to report a claim:

  • Small Business Customers call:
    1-844-325-2467 (844-3-CLAIMS)
  • Mid/Large Business Customers call:
  • Customers >1,000 employees:
    Report a casualty claim online

​Assigned Risk Services

Contact assigned risk services through the forms listed below.

Need something not listed above?

Contact us
Send us questions / comments