Raleigh Office Carrier Partners

This form must be filed with the Industrial Commission within two years of the date of injury or occupational disease or your claim may be barred.

Notice shall be given to the employer immediately after the accident or as soon as practicable and within 30 days.

Raleigh Office
Claims management

Download Employee FormDownload Employer Form

In the event an employee is injured on the job:

Complete either the Employer’s First Notice of Injury or Disease form for all claims, with as much information as you have at that time.
Most of our insurance partners prefer that Workers’ Compensation Claims are reported directly.
Forward a copy of the First Report to us. We'll follow up with the insurance company for their prompt handling of this claim.

After we report the claim to the insurance company, the claims adjuster will:

Contact you, the injured employee and the physician to discuss the accident to.
Request copies of bills and doctors’ reports for medical treatment.

What information do I need to report a claim?
In most situations, we only need the basics (what?, when?, where?, who?). The more information you can provide, the better but don’t wait to report your claim. Click below based on your claim type to learn more.

Workers' Comp ClaimsCarrier Contact Directory

FORM 19, EMPLOYER

Employer must furnish a copy of this form, as completed, to the employee or the employee’s representative when submitted to the Insurance Carrier or Claims Administrator for transmission to the Commission. Every question must be answered. This Form 19 must be transmitted to the Commission through your insurance carrier/claims administrator, and is required by law to be filed within 5 days after knowledge of accident.

Employer must also give employee a blank Form 18.

Property Claims

In the event of damage to your building or contents:

1. Protect the property from further damage.

Cover the property if it is exposed to the elements.
Make repairs, if reasonable and necessary, to protect the property from further damage.
Maintain a record of all expenses incurred protecting the property.
Separate damaged from undamaged personal property, if possible.

2. Take photos of damage preferably before you take protective action.

3. Call us to report the loss.

4. Prepare inventory of personal property damage

List quantity, description, actual cash value and amount of loss.
Attach bills, receipts and related documents.

5. Retain damaged property until a claims adjuster approves disposal (unless a danger to safety).

The adjuster may need to inspect the property.
The insurance company may be able to salvage the damaged property.

6. Notify police in the case of a theft.

7. Be prepared to provide additional documentation as requested by the adjuster.

8. Expect to be contacted by the claims adjuster within 48 hours.

If the damage significantly affects your continuing operation, we'll request that the insurance company expedite your claim.
Let us know immediately if your circumstances change and this loss will have a greater effect on your business than originally anticipated.

After we report the claim to the insurance company, the claims adjuster will:

1. Contact you by phone, mail or email to discuss the loss.
2. Arrange for an appraiser to inspect damaged property.
3. Assist you in the choice of contractors to make repairs.
4. Contact you for a settlement.

Complete Property Claims Reporting Form

Use the Following if a Potential Business Interruption Claims is Involved

1. Record all expenses incurred due solely to the loss

Wages for employees involved in clean up or repair
Overtime paid for employees to fulfill orders that would have been completed during normal hours if not for the loss
Outside venders involved in clean up, repair, etc
Leasing of temporary space until your facility is repaired
Leasing or purchase of any items necessary to continue operations
Other

2. Record all expenses that you continue to incur despite the necessary suspension of your operations

Wages for employees who were sent home but still paid (may be covered for continued payroll)
Other
Document any business lost due to the necessary suspension of your operation Canceled orders
- Refused orders
- Other

3. Complete financial records may be necessary to determine your lost income due

Your accountant may be able to help, especially if your on-location financial information was destroyed due to the loss.
The insurance company may assign an accountant to determine the exact amount of your loss.

Restoration Companies

Carolina Restoration Services
Eastern Restoration and Disaster
RestorePro Reconstruction
SERVPRO

Liability Claims

In the event of injuries or damage to property of others which you allegedly caused:

Call us to report the claim.
Provide all documents you have regarding this incident.
Provide a copy of the lawsuit, if filed.
Obtain and provide all documents available to the claimant, including medical bills.
Provide all internal documents including accident investigation, repair and maintenance records, etc.
Maintain a list of names and addresses of any witnesses to the incident or employees who may be able to provide details on the product or location involved in the incident.
If a product is involved and you have the product, save it for inspection by the claims adjuster or an expert named by the insurance company.
The claims adjuster will work directly with the claimant or his/her attorney; you should not interact with the claimant yourself.
Expect to be contacted by the claims adjuster within 48 hours.

Complete Liability Claims Reporting Form

After we report the claim to the insurance company, the claims adjuster will:

Contact you to discuss the incident that allegedly caused the injury or damage to property.
Deal directly with the other party and/or attorney to handle the claim.

Auto Claims

In case of an automobile accident:

Report to the police.
Collect details of others involved (name, contact info, insurance, vehicle type, license numbers).
Take photos.
If the vehicle is undriveable, tow it to the nearest repair shop, but don't authorize repairs until the claims adjuster approves.
Call us to report the accident.

In case of windshield damage, vandalism, or theft:

Report the incident to the police.
Call us to report the loss.

Complete Auto Claims Reporting Form

After we file the claim:

The claims adjuster will contact you for details and repair estimates.
They may arrange for an appraiser if necessary.
The adjuster will handle settlement and communicate with others involved.

Note: Do not speak directly to others involved; refer them to your claims adjuster.

After Hours Carrier Contact Information

Auto ClaimsProperty ClaimsLiability Claims

Phone:
919-469-2473
Toll-Free: 800-277-7702

Fax:
919-467-4987

During regular business hours, for all lines other than Workers’ Compensation, call our office at 919‐469‐2473. After hours, weekends and holidays and claim emergencies, call directly to your carrier. Visit our contact directory below.

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View the carrier websites for more information on how to submit a claim after hours.

Phone:
919-469-2473
Toll-Free: 800-277-7702

Fax:
919-467-4987

In the event an employee is injured on the job:

After we report the claim to the insurance company, the claims adjuster will:

What information do I need to report a claim?In most situations, we only need the basics (what?, when?, where?, who?). The more information you can provide, the better but don’t wait to report your claim. Click below based on your claim type to learn more.

In the event of damage to your building or contents:

After we report the claim to the insurance company, the claims adjuster will:

Use the Following if a Potential Business Interruption Claims is Involved

1. Record all expenses incurred due solely to the loss

Document any business lost due to the necessary suspension of your operation Canceled orders

Refused orders

Other

3. Complete financial records may be necessary to determine your lost income due

Restoration Companies

In the event of injuries or damage to property of others which you allegedly caused:

After we report the claim to the insurance company, the claims adjuster will:

What information do I need to report a claim?
In most situations, we only need the basics (what?, when?, where?, who?). The more information you can provide, the better but don’t wait to report your claim. Click below based on your claim type to learn more.