Agent Resources

Get a Quote

Risk Innovations recognizes the importance of fast and efficient quoting. We have several online quoting capabilities to ensure your experience is quick and easy. Let’s get started!

Personal Lines

USLI Phone Quotes

With just a few questions, we can provide an instant USLI phone quote for Personal Line Products. No applications needed!

Get started today by calling
866-578-7046

Underwriters are available Monday-Friday 7am-8pm EST and Saturdays 9am-1pm EST.

USLI Online Quotes

USLI’s online system provides quick quotes 24/7. Simply select the product you want to quote below to get started:

PERSONAL PRODUCTS

Surplus Lines Homeowners Quotes

We specialize in monoline Surplus Lines homeowners risks with unique market access and underwriting expertise to fit your clients’ needs.

For all other personal lines business,
email pl-nb@riskinnovations.com.

Workers’ Compensation

Workers’ Compensation Quotes

With niche programs and exclusive underwriting guidelines within most of our markets, no one does Workers’ Compensation better than Risk Innovations.

For select states, use the link below to get an indicated premium based on the class code / payroll / experience mod.

For all other workers’ compensation business,
submit your Acord 130 application to wcsubmit@riskinnovations.com.

Carrier Contacts

Billing Contacts

Workers' Compensation Billing Contacts

Accident Fund: 866.206.5851

AIG: 800.645.2259

Amerisafe: 800.256.9052

AmeriTrust: 800.825.9489

Amtrust: 877.528.7878
Online Payments

BerkleyNet: 877.497.2637 (Inquiries)
Online Payments

Berkley: 800.448.5621

Cimarron: 833.564.3117

Berkshire: 800.488.2930

C.N.A.: 877.574.0540

Employers: 800.677.3252

Everest: 877.604.1995

FFVA: 800.346.4825

Guard: 800.673.2465

ICW: 800.877.1111

Inspirien: 800.821.9605

Key Risk: 800.842.0225

Markel: 888.500.3344

Michigan Commercial Insurance Mutual: 877.925.9911

National Liability & Fire: 844.229.9288

Normandy: 866.688.6442

Old Glory: 888.838.6404

QBE: 800.609.0401

RTW: 800.789.2242

Sirius/Pie: 855.705.2716

Southeast Personnel: 866.800.0785

Stonewood: 800.780.7454 (Inquiries)
Online Payments

Synergy: 866.710.0908

United Heartland: 866.206.5851

Zenith: 800.440.5020

Personal Lines Billing Contacts

AIG: 866.856.6855

Axa: Contact Risk Innovations

Berkley Asset Protection: 860.380.1189

Chubb: 800.682.4822

Hudson: Contact Risk Innovations

Ironshore: 844.311.0010

Lexington: Contact Risk Innovations

Lloyd’s of London: Contact Risk Innovations

Nautilus: Contact Risk Innovations

Palomar Specialty: Contact Risk Innovations

State Auto: 888.999.8103

Claims Contacts

Workers' Compensation Claims Contacts

Accident Fund:
866.206.5851 (P)
517.316.2775 (F)
claims@accidentfund.com

AIG:
866.642.5246 (P)
www.aig.com/reportaclaim

Amerisafe:
800.699.6240 (P)
services.amerisafe.com/portal/Default.aspx

AmeriTrust:
800.825.9489 (P)
800.832.8793 (F)
newclaim@meadowbrook.com

Amtrust:
866.272.9267/FL: 888.225.2442 (P)
877.669.9140/FL: 561.241.3257 (F)
AMTRUSTCLAIMS@qrm-inc.com
FL: FLclaims@amtrustgroup.com

Berkley:
800.448.5621 (P)

BerkleyNet:
800.435.1127 (P)
866.275.6320 (F)
claimops@berkleynet.com

BHHC:
800.661.6029 (P)
800.661.6984 (F)
newclaim@bhhc.com
https://bhhcpolicyholder.bhhc.com/Client/External/Claims

Cimarron:
877.296.6378 (P)

C.N.A.:
877.262.2727 (P)
800.953.7389 (F)
lossreport@cnaasap.com

Employers:
888.682.6671 (P)
877.329.2954 (F)
ecfroi@employers.com

Everest:
800.267.1676 (P)

FFVA:
800.226.0666 (P)
321.214.0235 (F)
ClaimsNOI@ffvamutual.com

Guard:
888.639.2567 (P)
570.825.0611 (F)
www.guard.com/docs/ClaimReport.pdf

ICW:
877.442.9669 (P)
www.icwgroup.com/workers-compensation/pc/contact-us.html

Inspirien:
800.821.9605 (P)

Key Risk:
866.847.8872 (P)

Markel:
800.362.7535 (P)

Michigan Commercial Insurance Mutual:
888.922.5246 (P)
517.8863499 (F)
newclaims@mcim.com

National Liability & Fire:
844.549.2512 (P)

Normandy:
877.404.6442 (P)

Old Glory:
800.765.2412 (P)

QBE:
844.723.2524 (P)
NewLossQBE@us.qbe.com

RTW:
866.620.3137 (P)
866.286.5258 (F)
claims@stateauto.com

Sirius/Pie:
855.275.9871 (P)

Southeast Personnel:
800.966.5562 (P)
727-682-2439 (F)

Stonewood:
866.459.1349 (P)
888.629.5821 (F)
claims@stonewoodins.com

Synergy:
866.710.0908 (P)
www.synergyinsurance.net/report-a-claim

Zenith:
800.440-5020 (P)
800.440.5022 (F)
firstcallnewclaim@thezenith.com
www.TheZenith.com/ri

Personal Lines Claims Contacts

AIG Claims: 888.760.9195

AXA / MiniCo: 212.415.8433

Chubb Claims: 800.252.4670

Ironshore Claims: 800.466.9165

Lexington Claims: 800.931.9546

Lloyd’s of London Claims: 856.853.8200

Markel: 800.362.7535

State Auto Claims: 800.766.1853

USLI: 888.523.5545

Forms and Applications

Workers’ Compensation

State-Specific Forms

AK – Petition Officer Waiver 07-6131
AL – DFW Credit
AL – DFW Credit-Recert
AL – Form WC14-15 – Employer Notice Include Exclude
AR – Drug Free Workplace Form
AR – Notice of Election/Revocation of Coverage
AZ – Employee’s Notice Of Rejection Of Terms
CA – Accident Fund Corporate Officer and Director
CA – Accident Fund General Partners and LLC Managing Members
CA – AIG Cooperative Corporation Officer – Director
CA – AIG Corporate Officer and Director
CA – AIG General Partners and LLC Managing Members
CA – AIG Professional Corporation Owner
CA – AmeriTrust Corporate Officer and Director
CA – AmTrust Corporate Officer and Director
CA – AmTrust General Partners and LLC Managing Members
CA – BerkleyNet Cooperative Corporation Officer – Director
CA – BerkleyNet Corporate Officer, Director or Trustee
CA – BerkleyNet General Partners and LLC Managing Members
CA – BerkleyNet Professional Corporation Owner
CA – Berkshire Corporate Officers and Directors
CA – Berkshire General Partners and LLC Managing Members
CA – CNA Corporate Officer and Director
CA – CNA General Partners and LLC Managing Members
CA – Employers – All Entities
CA – Guard Cooperative Corporation Officer – Director
CA – Guard Corporate Officer and Director
CA – Guard Corporate Officer, Director or Trustee
CA – Guard General Partners and LLC Managing Members
CA – Guard Professional Corporation Owner
CA – Guard Trusts
CA – ICW – All Entities
CA – Markel Corporate Officer and Director
CA – Markel General Partners and LLC Managing Members
CA – New York Marine and General Insurance Company Officer and Director
CA – New York Marine and General Insurance Company General Partners and LLC Managing Members
CA – NL&F Cooperative Corporation Officer – Director
CA – NL&F Corporate Officer and Director
CA – NL&F General Partners and LLC Managing Members
CA – NL&F Professional Corporation Owner
CA – NL&F Trusts
CA – Pie All Entities
CA – Protective Corporate Officer and Director
CA – Protective General Partners and LLC Managing Members
CA – QBE – All Entities
CO – Exclusion Of Coverage Form WC43
CT – Form 6B-1 – Coverage Election Emps Of Partnership
CT – Form 6B – Coverage Election Offcr Mngr Member
CT – Form 75 – Coverage Election SProp Sing Mmbr LLC
CT – Drug And Alcohol Free Workplace Program Form
DE – Officer LCC Member Exclusion Form
FL – Form DWC-250 – Notice Election To Be Exempt
FL – Form DWC-250 – Notice Election To Be Exempt – INS
FL – Form DWC-250R – Notice Revocation Election Exempt
FL – Form DWC-251 – Notice Election Of Coverage
FL – Form DWC-251-R – Revocation Election Of Coverage
GA – Drug Free Credit Form
GA – Form WC10 – Notice Of Coverage Election Rejection
IA – 14-0061 – Exclusion
IA – Non Election Form 14-0175
ID – IC52 – Election Of Coverage Form
IL – Exclusion Corporate Officer and LLC Member
IL – Exclusion Sole Proprietor and Partners
IN – Exclusion or Election Form
KS – WC-50a – Cancellation Of KS WC-50
KS – WC-50 – Exclusion Form
KS – WC-113 – Election Of Individual
KS – WC 114 – Cancellation Of KS WC 113
LA – Exclusion or Election Form
MA – Form 153 – Corporate Officers Exemption
MD – Form C-15R – Inclusion Form
MD – WCC Exclusion Form IC-16
ME – Form WCB-2C – Application For Waiver
MI – Rejection Of Coverage Form
MO – Rejection Of Coverage LLC Forms1
MS – Rejection of Coverage Form
NC – Drug Free Workplace Form
NC – Drug Free Workplace Form – Instructions
NC/SC/VA – Notice of Election or Rejection
NE – LLC Inclusion Form
NJ – Form PP-1B – Proprietors Partners Election
NM – CID Sole Proprietor Election Form
NM – Election To Be Subject To WC Act
NM – Executive Employee Affirmative Form
NM – Revocation Of Prior Election Form
NV – Rejection of Coverage Form
NV – D-45 – Sole Proprietor Coverage
NY – Form C-105 32 – Elect SProp Partner LLC Memb
NY – Form C-105 51 – Exclude Shrhldrs And Exec Offcrs
NY – Form C-105 52 – NonProf Exclude Unslrd Exec Offcr
NY – Form C-105 53 – Revoke Election For NonProf Org
NY – Form C-105 55 – Rvk Shrhldrs ExecOffcrs Exclusion
PA – Form LIBC 509 – Ap For Exec Officer Exception
PA – Form LIBC 513 – Executive Officers Declaration
RI – Form DWC-11 – Claim Of Common Law Rights
RI – Form DWC-11C – Elect By Exempt Corp Off
RI – Form DWC-11R – Rescnd Common Law Rights Claim
SC – Form 5 – Corporate Officer Notice To Reject
TN – Form SS-4523 – Construction Exemption
TN – Form I-4 – Election Of Sole Proprietor Or Partner
TN – Form I-5 – Notice Of Withdrawal Sole Proprietor
TN – Form I-6 – Notice Of Corp Officer To Employer
TN – Form I-7 – Notice Corp Officer Rev Exemption
TN – Form I-8 – Notice Of Acceptance By Employer
VA – Notice Terminate Prior Rejection Of Cvrg
VA – Rejection Of Coverage Form
VT – Form 29 – Exclude Corp Officers Corps Ap
WV – Rejection Or Election Form

Get Appointed

To get appointed with Risk Innovations, please complete the following items and send them to:  marketing@riskinnovations.com

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Risk Innovations Broker Agreement

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Agency Profile

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W-9

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ACH Authorization Form and copy of voided check

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Copy of current state agency license

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Copy of current Errors & Omissions Dec Page ($1MM+ limit)

Risk Innovations Broker Agreement

Risk Innovations Broker Agreement (CA Agents)

Agency Profile

ACH Request Form

W-9

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Don't forget:

Sign and date all forms.

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Please include:

A copy of your agency’s current E & O declarations page and a copy of your agency’s license.

Important notice. Completion of these forms does not constitute an appointment in any way with Risk Innovations. Your agency will be contacted after careful review of your paperwork, and, if approved, your agency will be assigned a unique producer identification number. Binding authority is not extended to any individual agent or agency.

1-800-913-6696     marketing@riskinnovations.com