Existing Claim Question: BSC

Existing Claim Question
BEFORE CONTINUING:

IF YOU NEED TO REPORT A NEW INJURY CLAIM OR IF YOU ARE SUBMITTING A NEW INJURY CLAIM ON BEHALF OF INJURED INDEPENDENT CONTRACTOR:

PLEASE DO NOT FILL OUT THIS '{form_title}' AND CLICK HERE: START A NEW CLAIM

IF CONTINUING:

IF YOU CURRENTLY HAVE A CLAIM WITH BLUE STAR AND NEED TO ASK A QUESTION ABOUT YOUR CLAIM:

PLEASE CONTINUE TO FILL OUT THE FORM BELOW.
Name of person filling out this form*

First NameLast Name
Are you the independent contractor?*

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Name of independent contractor

First NameLast Name
Your Phone Number*
Please enter a valid phone number.
Your Email Address*
What Company were you providing services for, if applicable?
Do you know the claim number? It usually starts with OCC
Do you know the adjuster's name? If you don't know, leave blank.
What is your question?*
Should be Empty: