Notice of Claim or Potential Claim – EPL

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 EPL Case

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EMPLOYEE: (claimant /plaintiff/complainant)

Event and Allegation Details

E.g., race, color, gender identity, age

CRICO Insured Information

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

Case Type

You will be prompted for specific documentation for some of these items.

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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