Report an Injury

The easiest way to report a claim is online. If you have your user ID and password for our policyholder website then click here to login. After you submit the claim, you can print a copy for your records.

You have a variety of options for reporting a claim:

  • You can file a report on eClaim. Available in these states: AK, AZ, CA, CO, NV, and TX.
  • Contact your claims rep during business hours
  • 24/7 Call Center at 888-336-7569
  • Claims email:
  • Claims fax: 818-789-7286

If this is your first time accessing our policyholder site, you can register online. To register, you need your policy number, the policy effective date, and the Web Access Code, which you can find in your Claims Kit. Additional help is available at 818-382-1007.

If you want to email or fax your claim, please use the dropdown menu below to find your state and click to download the form. Complete the document, save to your computer, and then attach the file to your email or fax and send to or fax to 818-789-7286.


Send form to e-mail
If you want to email your completed form, simply click on the link above and then attach your state form.