Notice of Claim or Potential Claim

CRICO/Risk Management Foundation
1325 Boylston Street
Boston, MA 02215

CRICO will receive the information you enter on this form when you click submit. If you have further questions, please contact your CRICO Claims Department.

The data collected here follows the privacy and security practices in our Privacy Policy.

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Form to Submit a New Case

Please wait a few seconds after you click Submit. Because there are attachments, it takes a moment to load and send the information. You will see a thank you page and receive an email when you are done.

Claimant Information

Event Details

CRICO Insured Information

Please complete the fields in this section with the name and email address for each insured involved in this event.

If the employee no longer works here, enter the end date as well.

If the employee no longer works here, enter the end date as well.

If the employee no longer works here, enter the end date as well.

Case Type

Enter up to six attachments totalling no more than 10 MB for one of the following.

For a claim, attach the claim letter.
For a suit, attach the summons and complaint.
Provide relevant documents for a potential claim, legal assist, e.g. regulatory complaint, subpoena, request for medical information, etc.

Claim Manager

If needed, see the CRICO Claim team page to select the proper team that will support this case. The team's manager will be instantly alerted when you submit the form.

This report is to be used as a notice of specific circumstances involving a particular person or property. It is a confidential preparation for litigation. It is not a part of the patient’s record.

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