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Request materials

Request claims and other materials

You can use this form to request claims, fraud and risk management materials. Simply mention the document title and list the quantity you need. You will receive an email copy for your records.

  Your information
* Your Name:
* Email:
* Company:
* Policy number: -
Example: WSD - 1234567
  Where should we mail the materials?
* Street:
* City:
* State:   Zip:
  Which materials are you requesting?
* List the items and quantity for each:

(500 character limit)

  Captcha Validation

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If you experience difficulties submitting this form, simply print and fax to:

ICW Group
Attn: Workers' Compensation Underwriting
Fax: 858.350.2616