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Report a Claim by Fax or Mail

All IMLRMA members are encouraged to report claims via iCE™ (Internet Claims Edge). iCE™ is a state-of-the-art online reporting tool that benefits IMLRMA members. If you would like in-person training on using iCE™, please contact your Membership Field Representative.

To Report a Claim via Fax or Mail




  1. Select either the Workers' Compensation Claim Forms or the All Claims Other than Workers' Compensation Form and you will be redirected to the appropriate page from which you may select an Adobe PDF or Microsoft Word version of the form.
  2. Fax the completed form to (312) 455-6477, or
  3. Make a copy of the form for your files and mail the completed form to:
    • IMLRMA
      c/o CCMSI
      114 S Racine Ave, Suite 200
      Chicago, IL 60607-2968
    • If you are unable to download the form or if you have questions about the form, please contact us at: 866-908-9230.
    • After we receive your claim report, the IMLRMA Claims Team will send an acknowledgement letter to the RMC confirming receipt of the claim and giving the IMLRMA claim adjuster's name who is assigned to your case.
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