As an added service, Bollinger offers you the opportunity to check the status of your claim online. One of our claims representatives will respond promptly to your request via e-mail. Required fields are highlighted.

Your Name:

E-Mail:

Claimant Name:

Claimant city or state:

College or University:

Date of Injury:

Description of Injury:

Questions or Comments:

Would you like a follow up call?:

Yes No

Phone number where you can be reached:

Note: Our office hours are 8:00am to 5:00pm EST.

Inquiring on behalf of:

Claimant Provider

Enter security code: (case sensitive)

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