How To Report a Claim

All claims should be reported by using one of the following methods:

By phone: 800-845-1209  By mail: The Mental Health Risk Retention Group
Attn: Maria Iula
103 Eisenhower Parkway
Suite 101
Roseland, NJ 07068
Download Accord Form
By fax: 973-830-8585
By email: miula@jjnegley.com


Submit Online: To Submit your claim online you must first download the Acord Form, fill it out completely and save it to your computer, then attach it below.

Claim Form


File Size: 1000KB Maximum

File Size: 1000KB Maximum

File Size: 1000KB Maximum

File Size: 1000KB Maximum

File Size: 1000KB Maximum

File Size: 1000KB Maximum

Only PDF files may be uploaded at this time.  Once you have completed the information above and attached your files please click the submit button.

* Required

In order to expedite this process, please provide as much of the following information as possible:

  • Insured’s policy number
  • Date, time and location of the loss/accident
  • Details of the loss/accident
  • Name, address and phone number of all involved parties
  • If applicable, name of law enforcement agency or fire department, along with the incident number.
  • For an update or status of a claim contact Maria Iula at 800-845-1209.