North America Chemical Users & Applicators Association

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To begin the claim filing process, please fill out the form below.

Claims Direct Access will work with highly experienced claims experts to ensure you receive frequent communication, professional advice, and professional representation throughout the entire process.

As an alternative to the online form, you can print/download the PDF version of the incident reporting form. When filled out, please send to

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IMPORTANT NOTICE: It is your contractual responsibility to report any Claim, Loss or lawsuit, or any incident or event which could reasonably lead to a Claim, Loss or lawsuit, directly to us as set forth in the Policy. If for any reason you are unable to use our Online Claims App for this purpose, it is still your responsibility to report any such Claim, Loss, lawsuit, incident or event to us as set forth in the Policy by another method such as by facsimile (Toll-Free) at 1-877-452-6909, by email at, or by telephone at 1-877-585-2849. Your failure to do so may jeopardize any coverage as set forth in the Policy.

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Accepted file types: jpg, png, pdf, tiff, bmp, heic, Max. file size: 20 MB, Max. files: 5.