Agent Resources

Get a Quote

Risk Innovations recognizes the importance of fast and efficient quoting. Our new business team will respond to your quote request within hours to either confirm receipt or request any additional information that may be needed.

To ensure the fastest turn around for quotes, please submit the following to our team:

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Completed Acord 130 Application

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Loss Runs

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Experience Modification Factor

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Please direct all new business quote requests 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

    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

    RAS:
    877.585.1117 (P)
    Complete the First Report of Injury form and email it to RAS at FirstReports@RASCompanies.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

    Forms and Applications

    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
    CA – Waiver of Workers Compensation Coverage – Corporate Officers/Directors
    CA – Waiver of Workers Compensation Coverage – General Partners & LLC Managing Members
    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.

    Send Your files

    Want to send us a new business submission?  Or agency paperwork to get appointed?  Easy breezy – just drop the files in the below tool and a team member will be in touch.






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