CLAIM REPORTING

Please click below for the
applicable claim form. 

Auto Loss and General Liability forms
Auto Loss Notice- fill-in form

Auto Loss Notice- standard form

General Liability Notice- fill-in form

General Liability Notice- standard form

Once the form is complete, please
e-mail  the completed form to:
Karen Berenato
Phone: 609-653-8400 x2302
Fax: 609-601-3173
kberenato@qual-lynx.com

Property Loss forms
Property Loss Notice- fill-in form

Property Loss Notice- standard form

Once the form is complete, please
e-mail the completed form to:
Joe Lisciandri
Phone: 609-601-3191
Fax: 609-601-3192
jlisciandri@qual-lynx.com

Workers' Compensation forms

Employee Accident Report - click HERE
Supervisor Report - click HERE
(Both reports must be completed and submitted after an injury is called in)

NJPHA Workers' Compensation Injury Reporting Procedure- click HERE

Workers' Compensation Injury Poster- click HERE

Managed Care Contact List- click HERE
Nurse Transition Statement- click HERE

Emergency Claim Reporting Procedures - click HERE

Our goal is to provide uninterrupted service to our valued
clients!

Please click HERE for a complete listing
of your Qual-Lynx account service team.