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Claim
Request information
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To file a claim, please be sure to fill out the information below:
Name
Telephone
Social Security Number
Fax # (if applicable)
Date of Birth
Email
ILA Local #
Address
Please fill in the information to receive your claim forms. We will assist you in filing your claim with the correct carrier. What type of Claim is this?Accident Sickness (Surgery)
The Accident occurred to whom:
Self
Spouse
Child
Where did the Accident occur?
On the Job
Off the Job
What is best way for you to receive the claim forms?
Email
Fax
Regular Mail
Additional Information
