Our priority is to provide exceptional service every day, especially when an employee has been injured on the job.
Please reference the information below and to the right to determine how and where to report your claim. If you are unsure, call us directly at (866)810-3264.
First Report of Injury
This form is required by law if the employee missed more than one day of work due to the injury or if the medical bills exceed $2,000. Please fax or mail this form immediately to our claims manager.
Brentwood Services Administrators, Inc. / Dealers Choice Mutual Insurance, Inc.
P.O. Box 471127
Charlotte, North Carolina 28247-1127
Notice of Accident to Employer and Claim of Employee, Representative or Dependent
In addition to providing the Form 19 to the Employee, the employer shall also provide a blank Form 18 for use by the employee.