IMPORTANT:
USER DIRECTIONS FOR CLAIM / LOSS REPORTING TO STATES

PLEASE READ THE ENTIRE CONTENTS OF THIS PAGE

This page provides you with a link to a claim / loss information submission form and to a dedicated email destination at States to receive notification of claim and loss information. You can also attach to the email any supplementary documents you may have to help enhance the claim or loss information.

This page can be used to notify States’ claim professionals of any loss information that should be reported to help States work with you, even if the situation has not given rise to a formal claim.

Please note that States' policy form has specific requirements for claim and loss reporting under various circumstances. We ask that you refer closely and regularly to your States policy for those reporting requirements.

TO REPORT A CLAIM OR SUBMIT LOSS INFORMATION TO STATES:
 
  1. CLICK HERE and then select "Save" to save a copy of the "NOTICE OF LOSS OR CLAIM FORM." Save the form to your computer in a place where you can store it for future reference and access it to attach to an email.

  2. Go to the place on your computer where you saved the "NOTICE" form and open it. The form is set up as an MS Word template and can then be completed on any computer running any recent version of MS Word.

  3. You will need to save the form once you’ve filled it in. You may wish to save it with a different file name to give it an identity that ties it to the information being submitted.

  4. Once you are ready to submit the "NOTICE" form and any other attachments, click on this link: StatesLossNotice@berkleyrisk.com. This should open your email application so you can attach the completed "NOTICE" form and provide any other information you wish to add. (If clicking on the link above does not automatically open your email application, simply copy and paste the email address into your email application.)

  5. Click on SEND in your email program to submit the email and its attachments. It will automatically go to a monitored email box at States and a States claim professional will review it and acknowledge receipt of it in a reply to you.

As a member-owned program, States’ success on your behalf is closely tied to timely claim and loss reporting. We appreciate your cooperation as we work on your behalf in this important facet of States’ operations.

Thank You!

States claim/loss information and communications can also be directed to:

States Self-Insurers Risk Retention Group, Inc.
ATTN: CLAIMS DEPT.
c/o Berkley Risk Administrators Company, LLC
P.O. Box 59143
222 South Ninth Street, Suite 1300
Minneapolis, MN 55459-9964

Emergency Phone: 612-766-3700
Fax: 612-766-3899
Email: StatesLossNotice@berkleyrisk.com

© 2000-2012 States Self-Insurers Trust / States Self-Insurers Risk Retention Group, Inc.
All Rights Reserved.
 
 
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