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Workers Compensation On-Line Claim Reporting

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Claims Reporting Forms

Transportation Loss Notice
This form gives you the ability to report a Auto/Truck Liability or Physical Damage Claim. In addition this form needs to be completed, when an auto or non-auto related claim occurs to the customers physical property (i.e. carpet/hardwood floor damage claim, driveway damage, stairway damage,damage, etc.)
Transportation Loss Notice (PDF)

Presentation of Loss and Damage Form
This form is designed to be filled out and emailed. IThis form is designed to be downloaded and printed. It needs to be completed when an Inland Marine Cargo/Warehouse Legal Liability Loss has occurred. In addition to this form, our office will need the following information: A copy of both sides of the Bill of Lading or Warehouse Receipt involved in the loss, a copy of the inventory information, and a copy of the shipper’s loss or damage form (if applicable). Please send to fax# 707-252-5905 or send this information to Claims via email: claims@paulhanson.com.
Presentation of Loss and Damage Form (PDF)

Business Property Claims Reporting Form
This form gives you the ability to a report a Business Personal PropertyThis form gives you the ability to a report a Business Personal Property or Real Property claim.
Business Property Claims Reporting Form (PDF)

General Liability Claim Reporting Form
This form gives you the ability to report a General Liability claim.
General Liability Claim Reporting Form (PDF)


The forms above are interactive PDF documents. Click on the form link to see the form in Adobe Acrobat. Please fill out the form and upon completion click on the Submit button to send the completed form to the claims department via email.