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1

Call 1.888.CLAIM.50

(1.888.252.4650)

Please call our 24 hour claims hotline to report any type of claim. High priority claims need to be reported via phone so they can be escalated to the proper person for handling.
   

2

Complete Forms

Save the file to your computer. Once completed, Save and proceed to next step.
   
 

3

Submit Forms


Submit completed documents by faxing them to:

978.531.4847


OR

Email completed documents to:

ClaimsReporting@Energi.com




Documentation to Gather

When reporting you will be asked to provide a copy of medical documentation from the injured employee that seeks treatment. Should the injured worker be placed out of work beyond the State requirement a Wage Statement will need to be completed and submitted. Should the injured employee be put on Modified/Light Duty - medical documentation needs to be obtained and submitted referencing medical restrictions. For authorization form click here.


Notice of Litigation or Correspondence From an Attorney

The injured employee may seek legal counsel relating to his workers compensation injury. If this occurs, immediately forward that correspondance to Energi.


Comments, Concerns, Questions

If you have any questions regarding these procedures, please contact the Energi claims team.

Email: ClaimsReporting@energi.com
Phone: 978.531.1822
Fax: 978.531.4847

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