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MAINE WORKERS' COMPENSATION BOARD
Insurance Carrier Contact Information
Claims Contact (primary party responsible for claims processing and reconciliation)
Name:
Title
Insurance Company Name
Address #1 (PO Box)
Address #2 (Street Address)
Suite/Floor # (if applicable)
City
State
Zip Code
Phone #
Coverage Contact (primary party responsible for filing Proof of Notice of Coverage with state)
Name
Title
Insurance Company Name
Address #1 (PO Box)
Address #2 (Street Address)
Suite/Floor # (if applicable)
City
State
Zip Code
Phone #
Audit Contact (primary party responsible for coordination of claims audit)
Name
Title
Insurance Company Name
Address #1 (PO Box)
Address #2 (Street Address)
Suite/Floor # (if applicable)
City
State
Zip Code
Phone #
Return to
Audit
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