{"id":18,"date":"2024-01-17T16:37:13","date_gmt":"2024-01-17T16:37:13","guid":{"rendered":"https:\/\/www.workplaceviolenceportal.com\/smi\/?page_id=18"},"modified":"2024-10-18T19:52:49","modified_gmt":"2024-10-18T19:52:49","slug":"report-a-claim","status":"publish","type":"page","link":"https:\/\/www.workplaceviolenceportal.com\/smi\/report-a-claim\/","title":{"rendered":"Report A Claim"},"content":{"rendered":"\n<p>If you have a claim that requires <strong>immediate<\/strong> attention, please call <a href=\"tel:866-957-3138\"><strong>(866) 957-3138<\/strong><\/a><\/p>\n\n\n\n<h3 class=\"wp-block-heading\">To submit a Workplace Violence claim, please complete the following form:<\/h3>\n\n\n\n<div class=\"wp-block-contact-form-7-contact-form-selector\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f22-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"22\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/smi\/wp-json\/wp\/v2\/pages\/18#wpcf7-f22-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"22\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.4\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f22-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<div class=\"form-row\">\n<div class=\"form-group col-6\">\n<label for=\"agent-name\">Name of Your Insurance Agent:<\/label>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"agent-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" id=\"agent-name\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"agent-name\" \/><\/span>\n<\/div>\n\n<div class=\"form-group col-6\">\n<label for=\"email-address\">Email address:<\/label>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"email-address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email form-control\" id=\"email-address\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"email-address\" \/><\/span>\n<\/div>\n<\/div>\n\n<div class=\"form-row\">\n<div class=\"form-group col-6\">\n<label for=\"insured-name\">Insured\u2019s Name:<\/label>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"insured-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" id=\"insured-name\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"insured-name\" \/><\/span>\n<\/div>\n\n<div class=\"form-group col-6\">\n<label for=\"insured-phone\">Phone Number of the Insured:<\/label>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"insured-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" id=\"insured-phone\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"insured-phone\" \/><\/span>\n<\/div>\n<\/div>\n\n<div class=\"form-row\">\n<div class=\"form-group col-6\">\n<label for=\"policy-number\">Policy Number:<\/label>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"policy-number\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" id=\"policy-number\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"policy-number\" \/><\/span>\n<\/div>\n\n<div class=\"form-group col-6\">\n<label for=\"date-incident\">Date of Incident:<\/label>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"date-incident\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date form-control\" id=\"loss-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-incident\" \/><\/span>\n<\/div>\n<\/div>\n\n<div class=\"form-group\">\n<label for=\"incident-description\">Description of what happened:<\/label>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"incident-description\"><textarea cols=\"40\" rows=\"4\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea form-control\" id=\"incident-description\" aria-invalid=\"false\" name=\"incident-description\"><\/textarea><\/span>\n<\/div>\n\n<div class=\"form-row\">\n<div class=\"form-group col-6\">\n<label>Is there a police report?<\/label><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"police-report\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"police-report\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"police-report\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span>\n<\/div>\n\n<div class=\"form-group col-6\">\n<label for=\"police-report-number\">Police Report Number:<\/label>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"police-report-number\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" id=\"police-report-number\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"police-report-number\" \/><\/span>\n<\/div>\n<\/div>\n\n<input class=\"wpcf7-form-control wpcf7-submit has-spinner btn theme-bg rounded-0\" type=\"submit\" value=\"Submit\" \/><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>If you have a claim that requires immediate attention, please call (866) 957-3138 To submit a Workplace Violence claim, please<\/p>\n<p class=\"text-center\"><a class=\"btn btn-jwbs\" href=\"https:\/\/www.workplaceviolenceportal.com\/smi\/report-a-claim\/\">Read More<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-18","page","type-page","status-publish"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Report A Claim - Berkley Program Specialists SMI<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.workplaceviolenceportal.com\/smi\/report-a-claim\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Report A Claim - Berkley Program Specialists SMI\" \/>\n<meta property=\"og:description\" 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