Incident Report Form

In order to effectively handle a claim, the following information may be required. Effective claims handling is a core value of service at Sandin Insurance Group. Please immediately call your agent, Anthony or Dave for assistance and further instruction. You may also fill out this claims form to help us establish details of the incident.

Sandin Insurance Group stands apart from other agencies for our effective communication between all parties we represent. We understand that having a claim can often be a scary and daunting experience; count on us to expedite the entire claims process. The first 48 hours of a claim can be the most important. Especially in Worker's Compensation insurance; we are here to assist you every step of the way!

 
  • Failed

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    Success

    Your incident report has been submitted successfully.
    We will do our best to respond immediately.

  • Please, leave this field blank

  • General Information
  • Incident
  • Injured Person Involved

    (if minor, provide parent/guardian contact info)

  • Witness
  • Witness