Request a Claim Detail Report

Our policyholders and their agents of record have a right to request a claim detail report for their policy. Our team will validate the information given and provide a claim detail report within 48 hours of receiving this form.

Please note that our team can provide up to 5 years claims history to:

The policyholder directly, based on the policies carried with Service Lloyds Insurance Company
The agency of record directly, based on policies represented by the agency

Please select from the following:

First Name

Last Name

Title

Agency/Branch

Email Address

Verify Email Address

Phone Number

Workers Compensation Policy Number(s)*

Named Insured (Policyholder Name)

Are you representing the Agency of Record for this policyholder?YesNo

Claim detail report may only be released to the policyholder or the agency of record. Please provide a valid email address for the policyholder or upload a valid release letter. Click here to view a sample release letter.

Choose File to Upload

OR provide a valid email address below

Policyholder Email Address

Verify Policyholder Email Address