Claim Reporting Instructions

If you receive a claim from a third party on an event covered through our Special Event Liability Group Insurance Trust, please provide us with the following information as soon as you become aware of the claim.

A completed "Report of Injury or Loss" notice. Please obtain information contained in the attached form and mail or fax to Diversified Risk Insurance Brokers, 2300 Clayton Road, Suite 300 Concord, CA 94520; FAX: 925-609-6550 within 24 hours or immediately if serious injury or death has resulted. If information is not complete, DO NOT DELAY -- many details can be obtained later.

A copy of the certificate of insurance issued to the event holder covering the event.

A copy of any incident, accident, or loss report taken at the time of the incident.

DO NOT admit liability to anyone.

DO NOT offer your opinion to anyone.

Claim Report Form

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Eligible States : Application Forms : Coverage Summary : Claim Reporting
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