PASB INSURANCE PROGRAM INFORMATION REQUEST

Insurance Program Information Request

We are requesting your assistance in gathering basic information about your insurance program. This information will help us better understand the needs of PSBA members and design a program that will be beneficial to all.

Step 1: Fill Out The Info

Your Name

Your Company Name

Approximate Number of Vehicles You Operate

Current Automobile Insurance Renewal Date

Current Automobile Insurance Carrier Name

Current Workers Compensation Renewal Date

Current Workers Compensation Insurance Carrier Name

Step 2: Upload Documents

In order to get the best program design for the members, copies of your current vehicle schedule, automobile, as well as Worker’s Compensation policies will be valuable in designing this program. You can either use the upload link below or email them to us at kgoda@trustrti.com.

A current vehicle schedule

Current automobile and workers compensation policies

Below is a sample email we ask you to send. To find out where to send it, below this sample is a list of all the insurance carriers’ contact information to request loss history. Please find your carrier and send this email to them.

Step 3: Request Loss History

Instructions For Request Loss History

Use email template below to request loss history from insurance carriers. Copy and paste with your information and then send to your specificinsurance carrier (emails noted below)

Subject: Loss Run Request – [Insert Your Company Name]

Dear [Insurance Carrier],

Please provide us with currently valued loss runs for the years we have had coverage with your company.

Our policy number is: __________ (If you do not have your policy number, you can still send the request without it.)

Thank you for your assistance.

[Your Name]
[Your Contact Information]

Step 4: Share Loss History

Once you receive the loss history report(s), please email them directly to:
kgoda@trustrti.com

Insurance Carrier Email Addresses

Insurance Carrier	Email Address
Nationwide	rmsolutions@nationwide.com
Selective	clientservicecenter@selective.com
Erie	culossrunrequest@erieinsurance.com
Philadelphia	claimsreport@phly.com
Lancer	lossruns@lancerinsurance.com
National Interstate	Commerciallines.customerservice@natl.com
Utica	Amendcld@uticanational.com
AIG	claims@glatfelters.com
Carolina Casualty	lossruns@carolinacas.com and ccilossruns@carolinacas.com
Encova	customerservicewc@encova.com
Hanover	clprocessne@hanover.com
Amerisafe	underwritingservices@amerisafe.com
Clear Spring	info@clearspringinsurance.com
Zenith	claimscustomerservice@thezenith.com
Eastern Alliance	policysupport@eains.com
Rockwood	lossreports@rockwoodcasualty.com