Report a Claim

Worker's Compensation

Claim Form

Fax Worker's Compensation Claim Form to United Heartland at 262-787-7701

Liability

Claim Form  

Fax Liability Claim Form to Statewide Services at  800-858-1536

or e-mail StatewideClaimsReporting@Statewidesvcs.com

Notice & Disallowance of Claims

Auto Physical Damage

      Claim Form 

Fax APD Claim Form to Statewide Services at  800-858-1536

or e-mail StatewideClaimsReporting@Statewidesvcs.com