Claims & Forms

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

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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