Claims & Requests

Call us for help with claims and requests.

Coverage cannot be bound or altered online. Complete the form below to have a service representative contact you to finalize your request.

Type of Inquiry *

First and Last Name *

Email Address *

City and State *

Phone *

Can we send you text / SMS messages? *

By selecting 'Yes' you consent to receive conversational text / SMS messages from Stafford-Leavitt Insurance Services. Reply STOP to opt-out, reply HELP for support. Message and data rates apply. Messaging frequency may vary. Privacy policy

Employer Name

Member Number

Comments *

County

Please note: Claims and change requests cannot be completed online. A service representative will need to contact you to finalize your request.