Claim Services

Your Job Isn't a 9-5. Neither is ours.

Because emergencies usually do not happen during normal business hours, our agents are available to you 24/7. CLICK HERE for our company directory, and feel free to call or text when you need us.

We are here for you in the event of a loss. Whether it’s a vehicle mishap, property damage (for building or personal property), or portable equipment claims, we are available throughout the entire process to offer valuable information and support.

In the event of an accident, here are the basic steps you may encounter:

Check yourself and assist with anyone else injured or protect property from further damage.
Call 911 and notify your insurance agency immediately.
Provide accurate information, including:
- Date, time, location, full name, and contact information of all involved parties
- Description of what happened, the damages, and injuries
- Names of any witnesses
- Description of make, model, color, of automobiles involved

Conveniently file and track your claim by selecting and downloading one of the forms from below. This online service includes the ability to upload photos and documents from your mobile device. Your policy number is not necessary to file an initial claim report.

Vehicle Accident
Property Damage
Portable Equipment
Liability / Other Incidents

ESIP Vehicle Accident Report Form – Download

Please Return All Completed forms to Our Office by Fax: 1-888-973-7891, E-mail, or by using our Secure File Exchange Portal

Accident & Health

Provident First Notice of Claim Form – Download

Group Term Life

Group Life Claim Form – Provident / New York Life – Download

Beneficiary Designation Form – Provident / New York Life – Download

Group Life Claim Form – McNeil & Company / The Standard Insurance Company – Download

Beneficiary Form – McNeil & Company / The Standard Insurance Company – Download

24 Hour Accidental Death & Dismemberment

AD&D Claim Form – Download

First Responder Assistance Program

Contact Information – Download