CLAIM REPORTING

Emergency Claim Reporting Procedures
Please click HERE

Please click below to view or print
the applicable claim form.

Auto Loss and General Liability forms
Auto Loss Notice- fill-in form

Auto Loss Notice- standard form

General Liability Notice- fill-in form

General Liability Notice- standard form

Once the form is complete, please
email the completed form to:
Laura Sable
Phone: 609-653-8400 x2047
Fax: 609-601-3173
lsable@qual-lynx.com

Property Loss forms
Property Loss Notice- fill-in form

Property Loss Notice- standard form

Once the form is complete, please
email the completed form to:
Joseph Lisciandri
Qual-Lynx
Property Claims Supervisor
Phone: 609-601-3191
jlisciandri@qual-lynx.com

Accident Investigation Report Form
Dear Valued Client:
For the workers' compensation claims, Accident
Investigation Reports are required to be
completed by the employee's supervisor and
emailed to Qual-Lynx.  Attached is a fillable
version of the Accident Investigation Report form
that is readily saved in your computer to
facilitate completion of the required information.

Please click HERE for this form.

Kindly share this fillable form with your Claim
Coordinators.  The completed Accident Investigation
Report should be emailed to froi@qual-lynx.com.

Initial reports of workers' compensation
claims should continue to be reported to Qual-Lynx
at 1-877-822-9368.

Injury Reporting Procedure - click HERE

Please click HERE for a complete
listing of your 2023 Qual-Lynx
account service team.

Please see the attached announcement from Qual-Lynx (please click HERE) which outlines the transition of the Monmouth JIF dedicated Nurse Case Manager (NCM).  The new NCM is Jean Lehnau.  Qual-Lynx has also assigned a "secondary" NCM role to Christina Williams.  This certainly is an enhancement for the Monmouth JIF Program.

The dedicated NCM will be handling lost time, all focus town claims, and medical only claims.  The role of the secondary NCM will be to assist the dedicated nurse in handling all overflow of medical only claims.

Both nurses are established with Qual-Lynx and we are confident that this will be a positive enhancement to our medical management program for the Fund.

Again, please see attached letter advising the Fund Commissioners of the transition with an updated contact list.  Please click HERE for the updated contact list.

Ms. Lisa Gallo, Client Services Manager, Workers' Compensation, Qual-Lynx is available via cell at 609-380-5288 if the members of the Monmouth JIF have questions or concerns during this transition.

Thank you,

Jason Thorpe, AINS
Senior Account Manager
PERMA Risk Management Services