Claims & Forms

Company Claim Phone # Claim Fax # Reporting Website
Travelers/Premier 877-425-2466 NA NA
Harleysville 800-892-8877 NA www.harleysvillegroup.com
Norfolk & Dedham Connolly Insurance Agency Inc, 508-238-8778 NA NA
NGM/National Grange 877-425-2467 NA www.msagroup.com
Peerless 800-522-7152 NA NA

All other carriers contact Connolly Insurance at 508-238-8778.

Workers Compensation Claimants
Refer to your policy kit for the claim department phone number to report a claim or contact us at Connolly Insurance.

FORMS:
All forms are in PDF format. If you need the Adobe PDF plugin to read these forms, please CLICK HERE to download it.

Employer injury or fatality report

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