If you prefer to download a PDF version of this form please download, complete, scan, and email to claims@occaccrisk.com
If the injury is NOT a medical emergency:
- Upon notification of an occurrence, an Accident Loss Notice should be completed. Do not delay in reporting the claim, even if you don’t have all the information. You will be notified of any additional information needed.
- The injured employee should complete the Employee Statement.
- The HIPAA release should be signed.
Mission Statement
OccAcc Risk is committed to the collection & delivery of concise and complete claim information in a timely manner. This commitment enables us to have a more positive effect on the total outcome of the claim.
Services
TOLL FREE
Phone: 877-467-7866
MAILING ADDRESS
PO Box 2414,
Boerne, Texas 78006