Claim Reporting
General
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Digital Claim Reporting Demo
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Digital Member User Account Setup
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Emergency Claim Reporting Procedures
Please click below for the applicable claim form.
Workers' Compensation Claim Forms
(Effective January 1, 2021, the Managed Care Provider is Qual-Lynx)
Accident Investigation Report Form
Dear Valued Client:
For the workers' compensation claims, Accident Investigation Reports are required to be completed by the employee's supervisor and emailed to Qual-Lynx. Attached is a fillable version of the Accident Investigation Report form that is readily saved in your computer to facilitate completion of the required information.
Please click HERE for this form.
Kindly share this fillable form with your Claim Coordinators. The completed Accident Investigation
Report should be emailed to froi@qual-lynx.com.
Initial reports of workers' compensation claims should continue to be reported to Qual-Lynx at 1-877-822-9368.
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Workers' Compensation Injury Reporting Procedure
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Workers' Compensation Emergency Posting Notice
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First Pharmacy Visit - Script Advisor - Form
Auto Loss and General Liability forms
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Auto Loss Notice - Fill-in Form
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Auto Loss Notice - Standard Form
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General Liability Notice - Fill-in Form
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General Liability Notice
Property Loss Forms
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Property Loss Notice Fill-in
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Property Loss Notice Standard