Claim Form Instructions

Policy Number: Select the State where the Injured worker is employed/typical work location: Date of Injury: Enter your email address:

What You’ll Need to Get Started

Before you begin, please have:
- Policy Number
- Injured employee's basic information
  (name, address, date of birth, occupation)
- Incident details
  (date, time, and brief description of accident)
- Medical provider and treatment information
About this form:
- You will have up to 4 hours to complete the submission
- Please work on one claim at a time
- We recommend printing a copy for your records before submitting
Need help?
- Phone First Call: 1-800-440-5020
- Email First Call: FirstCallNewClaim@thezenith.com
- Additional Attachments can be submitted to zmailcenter@thezenith.com