EIS - Make a claim | Alan Boswell Group

Please complete this claim form for all claims.

A claim can be made under EIS if your employee has been absent from work for at least three consecutive working days as a result of a musculoskeletal injury or a mental ill health issue, such as stress, anxiety, or depression.

A claim can also be made where your employee has been involved in a reported motor accident but has not necessarily been absent from work for three consecutive working days.

Make a claim

Our claims team has received your query and someone will be in touch soon.

To find out more about how we work and our ethos, simply click the button below.

Find out more about us

1

2

3

Page 1 of 3 : Contact details

Contact details

Title

First name

Last name

Telephone number

Your job title

Company name

Find your company address

Search with your company name, postcode or first line of the address

Address line 1

Address line 2

Address line 3

Town

Postcode

There is a problem with the address you have entered. Please check the address for errors.

Page 2 of 3 : Claimant details

Claimant details

Claimants first name

This is the name of the person who is off work

Claimants last name

Claimant date of birth

Claimant job title

Claimant address

Search with the postcode or first line of the address

Address line 1

Address line 2

Address line 3

Town

Postcode

There is a problem with the address you have entered. Please check the address for errors.

Claimant email

Claimant phone number

We'll prioritise landline calls.

Claimant mobile number

Page 3 of 3 : Claim Details

Claim Details

Type of claim

Is the absence a result of an incident which occurred whilst at work?

Yes

Unsure

First day of absence

Where was the motor accident reported?

Police station

Insurance company

Name of the police station or insurance company

What was the accident reference or claims reference number?

What was the date of the motor accident?

The claimant is suffering from:

Where is the injury?

Declaration

I confirm that, to the best of my knowledge, all of the information I have supplied is true and complete and I confirm that the claimant has given their informed consent for their personal details to be passed to and processed as required under the policy terms and conditions by Alan Boswell Insurance Brokers Ltd and their agents.

Agent

Char4

XStream Office Branch

XStream Customer Classification

XStream Client Type

XStream Exec Code

XStream Agent Code

XStream Insurance Company

XStream Policy Type

XStream Commercial Type

XStream Feed Name

XStream Occupation

XStream Source

XStream Source Extra

There was a problem with some of the information you entered. Please check the form for errors and try again.

A technical error occurred when trying to submit this form. Please call us to let us know.