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Report Online
Note: You will not be able to complete the submission process from saved or book marked forms.
Please do not close this window until after the Report form has been submitted.
 
Report By Phone
Report all job-related accidents and injuries by calling 1-800-511-0719. You'll reach a live person 24 hours a day, 7 days a week to answer your questions.

Reporting a Claim :
If you are reporting a serious or fatal claim please contact 911

Evergreen Insurance Inc. offers Insurance Claims Services ANYTIME. Just call 1-800-511-0719. Our specialized representative will take the claim information and begin processing it immediately, regardless of the time of day. To expedite your report immediately

To expedite your report immediately, click here to report your claim Online.

What you can expect when you file your Claim with Evergreen Insurance:
24-hour claim reporting 365 days a year
Immediate claim processing
Body shop referral through our PAR 100 program
Emergency business repairs by an approved Contractor

Online Claim:
After reporting your claim online to Evergreen Insurance Inc., a Claim Specialist will contact you within 24 hours. If your report a loss, one that involves death or hospitalization we will contact you the same day and, in most cases, within an hour of your claim.

For Life-Threatening Medical Emergencies:
Call 911 to arrange transportation to the nearest medical facility.
Call 1-800-511-0719 immediately.


When you call please have the following information ready:
Your policyholder number;
Description, date and time of accident;
Any injured person(s) name, address
Police report number

We hope you never need this service but if you do, for claim service, you can have the peace of mind that we are here.