AmTrust Claims

Workers’ Compensation for All States Phone: 866-272-9267 Fax: 775-908-3724 or 877-669-9140 Email: Amtrustclaims@qrm-inc.com

Non-Workers’ Compensation Phone: 866-272-9267 Fax: 877-207-3961 Email: anaclaimsreporting@amtrustgroup.com

• National Provider Directory
• California MPN

Payor ID: 12491
Name of Clearing House: Optum Property and Casualty Clearinghouse (OPCC)
Identification number: OPCC's Tax ID: 352170347
To obtain a claim number, please call: 877-528-7878

How the Provider Should Submit the Claim #: If the subscriber is the patient, the claim # should be sent in a 2010BA.REF*Y4 segment in X12 837 transactions;  otherwise, if the patient is different than the subscriber, the claim # should be sent in a 2010CA.REF*Y4 segment. For example, REF*Y4*CLAIMNUMBER~. Our “OPCC Companion Document” and "OPCC Connectivity Guide" both explain how to use our system, and can be found here.

Providers/bill submitters can call our OPCC Customer Support at 877-234-0449, or email OPCChelpdesk@optum.com.

1. Name of the insured and policy number 
2. Date, time and place of accident or incident
3. Description of accident or incident 
4. Name, phone and/or e-mail of person making the report

For Workers’ Compensation 

1. MUST have the injured employee’s social security number as it is required by law 
2. Description of injury 

For Property Claims

1. Physical address of the loss

2. If more than one building on property, must have specific building(s) involved

3. Type of loss, i.e., fire, theft, etc.

4. Description of loss or damage 

 

For Motor Vehicle (Auto) Claims 

1. Name, address and contact information of ALL parties involved.
2. Make, model and VIN of the insured vehicle 

3. Make, model of all other vehicles involved 
4. Current location of all vehicles 
5.  Name and contact information for each driver and all passengers 
6. Name and contact information any known witnesses 
 

For General Liability Claims 

1. Physical address of where the loss occurred 

2. Name, address and contact information for all persons claiming injury or damage 
3. Name and contact information any known witnesses  

• 24/7 call center, staffed by claims operators, allowing claimants, policyholders and producers to speak with a live person
• Injured employees, medical providers and others are paid without delay
• Return-to-work options are initiated through a joint effort among the employer, physician and injured employee
• Each business segment is supported by a senior position with a high level of experience
• Preferred One Source Repair Program streamlines claims handling for automobile repairs through quality, authorized collision repair facilities across the country

New York DBL Claims 

The forms required when an employee becomes disabled in NY and may be entitled to disability benefits are:

• DB-271S—Statement of Rights: The NY DBL law requires an employer to send a “Statement of Rights” – entitlement of benefits under the Disability Benefits Law to an employee, within 5 days after the employee has been absent from work for more than 7 consecutive days. This statement is in standardized format approved by the Workers' Compensation Board.

• DB-450—Notice and Proof of Claim: After the disability begins, Part A – Claimant and Part B – Health Care Provider statements should be completed, signed and the form returned to the employer for completion of Part C – Employer Statement. The form should then be submitted to Wesco Insurance Company. Claims should be filed within 30 days after the employee last worked and the physician has certified the employee is totally disabled. Failure to submit the claim within 30 days may result in a partial or total rejection of the claim.

New Jersey TDB Claims

The forms required when an employee in NJ becomes disabled and may be entitled to disability benefits is:

• DS-I – Division of Temporary Disability Insurance Claim for Disability Benefits: Claim form is used to file a New Jersey TDB claim when an employee becomes totally disabled while employed. Claim must be filed within 30 days of disability. The employer must send the employee a Disability Form (Form DS-1), containing the worker’s name, address, Social Security number and wage information needed to determine the worker’s eligibility for temporary disability benefits.

Send a completed claim form for NY and NJ to:
Wesco Insurance Company
PO Box 980, Bowling Green Station
New York, NY 10274
OR
via fax at 800-584-9303
OR
via email at DBClaims@amtrustgroup.com

Contact Information
To make a claim or to contact our claims department:
Attn: Claims Department
17771 Cowan, Suite 100
Irvine, CA 92614
949-553-8143 fax
claimsbox@inscodico.com