Claims Information for Healthcare Organizations

CLAIMS

HOW TO REPORT PROFESSIONAL LIABILITY, GENERAL LIABILITY AND DIRECTORS & OFFICERS LIABILITY CLAIMS
Security Breach claims must be reported within 3 days of the incident to miula@jjnegley.com

All claims should be reported by using one of the following methods:

By Phone :	862-286-3527	By Mail :	Negley Associates Attn: Maria Iula 389 Interpace Parkway; 4th Floor Parsippany, NJ 07054
By Fax :	866-865-5655
By Email :	miula@jjnegley.com
Submit Online: To Submit your claim online you must first fill out your Acord Form completely and save it to your computer, then attach it below.

Claim

Insured's Name*

Insured's Email Address*

Insured's Phone

Broker Agency Name

Broker Contact Name

Broker Email Address*

Broker Phone

Accord Form*
File Size: 2MB Maximum

Additional Files:
File Size: 2MB Maximum

File Size: 2MB Maximum

Only PDF files may be uploaded at this time. Once you have completed the information above and attached your files please click the submit button.

* Required

Privacy Statement

In order to expedite this process, please provide as much of the following information as possible:

Insured’s policy number
Date, time and location of the loss/accident
Details of the loss/accident
Name, address and phone number of all involved parties
If applicable, name of law enforcement agency or fire department, along with the incident number.
For an update or status of a claim contact Maria Iula at 862-286-3527.