Serving Connecticut's Healthcare Employers For Over 25 Years

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Members

• Introduction
• Benefits to Members
• Education Calendar
• Managed Care
  • Medical Care Plan
  • Nurse Case Management
  • Medical Care Plan Application
  • Rights and Responsibilities
• Claims Administration
  • How to Report Claims
  • Report a Claim
  • Run Report
  • Fraud Policy
    • Fraud Poster (PDF)
  • Claim Forms
  • Sample Policies (PDF)
  • First Fill Form (DOC)
• Loss Control
  • How To Contact Us
  • Loss Control Services
  • Focus Groups
  • Trust Supported Products
• Protection for Members
• Online Confidentiality Agreement

Report a Claim

To report a claim, please click here for the First report of injury form.

Once completed, print a copy for your records and click on the "Click here to submit form" button.

For electronic filers: click here

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