- First Report
- Supplemental Report
- Auto / GL First Report
- Third Party Administrator Approval Application
Requests for reimbursement should be sent to the Safety National claims contact responsible for the file. Please complete and sign the appropriate form below and include a detailed payment listing with summary of all payments made on the claim by payment category (i.e. indemnity, medical expense, etc.).
- Reimbursement Request Specific Excess
- Reimbursement Request Aggregate Excess
- Reimbursement Request Specific Excess (pro-rated expenses)