Request 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 copy of this form via email for your records.

  • Your information

    • Example: WSD-1234567
    • You can find your policy number on your billing statement, policyholder welcome email, or printed Claims Kit.
  • Where should we mail the materials?

  • Which materials are you requesting?

  • Captcha validation

  • * indicates required field


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

ICW Group
Attn: Workers’ Compensation Underwriting
Fax: 858.350.2616



Notice of Collection of Personal Information