844-200-7710CONTACT US About Why 7710? Programs Agents Policyholder Portal Resources Customer Service Filing a Claim 1 In case of emergency, medical treatment should be sought immediately at the closest directed care medical clinic or emergency room! 2 Supervisor to scan and email a copy of the following forms directly to 7710-claims@trean.com or your agent, or to the 7710 Insurance main office address below. A) To Be Supplied to and Completed by Employee Workers’ Compensation Injury Notice As a first report of injury, no longer than 24 hours following an accident – Form B DOWNLOAD Authorization to Disclose, Release and Use Protected Heath Information HIPAA – Form E DOWNLOAD B) To Be Completed by Supervisor (2 documents total) Supervisor Report of Injury Form C DOWNLOAD Employer Report of Industrial Injury State – Form A. Select your state from the dropdown, download and fill out the form. Alabama Arizona Arkansas Colorado Connecticut Delaware Florida Georgia Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico North Carolina North Dakota Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia West Virginia Wisconsin C) To Be Completed by Witness Witness Statement Form D DOWNLOAD D) Medical Reports Also attach any medical reports related to the claim NOTE: Remember to post the “Notice of state Workers’ Compensation Law” in areas accessible to ALL employees and to follow your specific state’s Department of Insurance reporting requirements. Claims Expertise Working together with our partner claims administrators, our proactive approach to workers’ compensation claims combines predictive data analytics, clinical review, claims expertise, and adaptive technology to lower costs and guide claims to better outcomes – including returning injured workers to a healthy, productive life at home and at work as soon as possible. Easy access to an array of managed care tools, resources, information and insight help our partner adjusters thoroughly understand the medical aspects of each claim and guide injured workers to the right care from the right provider at the right time. Our partner adjusters are also skilled in recognizing the signs of potential fraud and utilizing their special investigative unit resources to verify legitimate claims and to fight fraud when they find it. 7710 Insurance takes a proactive approach, assisting our policyholders by managing exposure and risk through our SHIELD program, in addition to managing each claim closely throughout the process. Download our Claims Program One-sheet LEARN MORE ABOUT S.H.I.E.L.D. Questions? NATIONWIDE 844-200-7710 customerservice@7710insurance.com Main Office 7710 Insurance Company 1 North Cantey Road, Suite 201 Summerton, SC 29148 Administrative Office 7710 Insurance Company 3250 Lacey Road, Suite 140 Downers Grove IL 60515 Signup for our newsletter to learn more. Why 7710? Programs Agents Policyholder Portal Resources Customer Service Claims About Terms & Conditions Privacy Policy Sitemap 7710 Insurance 3250 Lacey Road, Suite 140 Downers Grove, IL 60515 Phone: 844-200-7710 Trean Corporation administers the Workers’ Compensation program on behalf of both 7710 Insurance Company and its affiliate Benchmark Insurance Company © 7710 Insurance Company, 2021