Fill out the form below to submit a claim to Illinois Casualty Company. By submitting this form, you acknowledge that the information you have submitted regarding your claim or loss notice is accurate and detailed to the best of your knowledge.
You may also report a claim by phone to 800-445-3726 or 309-793-1700, by email to firstname.lastname@example.org, or Fax to 309-793-1707.
- Any person who knowingly files a statement of claim containing false or misleading information is subject to criminal and civil penalties.
- Applicable in Minnesota: A person who files a claim with intent to defraud or helps commit a fraud against an insurer is guilty of a crime.
- Applicable in Indiana: A person who knowingly and with intent to defraud an insurer files a statement of claim containing any false, incomplete or misleading information commits a felony.
** Minnesota Health Care Providers should contact the Claims Department at Illinois Casualty Company at 800-445-3726 to obtain
Claim Number: The claim identification number is reported in the 5010 ASC X12 837 TR3 as follows: Loope 2010 CA Patient Name REF Segments= Property and Casualty Claim Number REF01=Y4 (qualifier) REF02=Claim Number Reference Source: 5010 ASCX12 837 TR3 Implementation Guide available at www.wpc-edi.com