Submit a Claim – Blair and Co.

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We are a TPA well equipped to handle all of your claims needs.
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Remote Access
- Client Login

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Home
Who We Are
What We Do
Claims

Claims Management & Administration

Financial Administration

MI Reporting

Loss Runs

Compliance

Medicare Compliance & Reporting

U.S., U.K. & Lloyd’s Regulatory Compliance

Information Technology

IT Infrastructure

CLAIMS System

Business Continuity & Disaster Preparedness

Client Access

We are a TPA well equipped to handle all of your claims needs.
Contact Us
Remote Access
- Client Login

Contact Us / Submit A Claim

Submit A Claim

Submit Claim

1Tendering Party

2Insured

3Claimant

4Assigment

5Attachments

6Verification

Your First name *

Your Last Name *

Your Company Name

Reported By *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number *

Fax Number

Email Address *

Your Claim Number

Insured Information

Same as tendering party.

Insured Company Name

Insured Last Name *

Insured First Name *

Policy Number *

Effective Date From *

Effective Date To *

Insured Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number *

Phone Type

Cell
Home
Work

Secondary Phone Number

Phone Type

Cell
Home
Work

Email Address

Claimant Company Name

Claimant Last Name

Claimant First Name

Claimant Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number

Claimant Email

Type of Assignment *

Loss Description *

Date of Loss/Accident

DOL Not Known

Date of Loss/Accident is not known

Loss Location

Same as Insured

Address *

Address Line 1

City

State

Code Postal

Assigment

Please upload copies of the policy, declaration page, photos of loss, tender letter, pleadings, and/or any additional documents pertaining to the loss being submitted.

File Upload

Click or drag files to this area to upload. You can upload up to 10 files.

*Acceptable File Formats: jpeg, jpg, gif, png, bmp, tiff, tif, pdf, doc, docx, xls, xlsx, txt, wpd

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This is a preview of your submission. It has not been submitted yet!
Please take a moment to verify your information. You can also go back to make changes.

Submit Claim

Your First Name

Your Last Name

Your Company

Your Address

City

State

Zip Code

Phone Number

Ext.

Fax Number

Email

Your Claim Number

Insured information

Same as tendering party.

Insured Company Name

Insured Last Name

Insured First Name

Policy Number

Effective Date From

Effective Date To

Insured Address

City

State

Phone Number

Ext.

Cell Home Work

Secondary Phone Number

Ext.

Cell Home Work

Email

Claimant Company Name

Claimant Last Name

Claimant First Name

Claimant Address

City

State

Zip Code

Phone Number

Type of Assignment

Loss Description

Date of Loss/Accident

Loss Location

Same as Insured

Address

City

State

Zip Code

Assigment

Attachment Info

Blair & Company is focused on helping clients solve their claims handling needs

Contact Us

Get in touch

Phone: (800) 487-1263
Fax: (866) 487-0476
Email: [email protected]

Western Regional Office

28025 Smyth Drive
Valencia, CA 91355

Eastern Regional Office

3111 Springbank Lane, Suite C
Charlotte, NC 28226

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