File a Claim
This form should not be used to file workers' compensation claims. Workers' compensation claims must be directly filed with the carrier within 24 hours of the event.
Click Here to File a Workers Compensation Claim
Need to file a claim? Mountain State Insurance Agency is here to help you. Don't wait- it's important to contact us as soon as you are able to report your claim!
Please fill out this form with some basic information in order for us to help you start the claims process. For assistance, please contact our Claims Specialist, Lisa Litton, at (304) 341-1217 or firstname.lastname@example.org.