Submit a Claim

Workers' Compensation losses should be submitted directly to the appropriate insurance carrier. Most states have specific forms that guide you through the process. New York, for instance, has the C-2F Workers' Comp Form . Contact the SterlingRisk claims team with any questions.

Incident Information

SterlingRisk Client

Date of occurrence

Time of occurrence

Type of incident

AutomobilePropertyOther or Unknown

Hint:

Auto - any incident caused by the operation of an automobile

Property - an incident that caused damage to your property

Address or location of incident

Description of incident

Was another vehicle or pedestrian involved in the incident?

Was someone injured as a result of the incident or did someone else's property get damaged?

Injured Party

Injured party's name

Hint: Enter the name of the person who was injured or whose property was damaged as a result of the incident. It can also be the name of a company if they are the owners of the damaged property.

Age

Gender

Parent's name (if applicable)

Address

Telephone

Description of injuries or property damage

Medical attention given

Witness Information

Witness name, address and telephone #

Prepared by

Name

Title

Telephone #

Contact Information