For claims, contact the appropriate person at:

Excalibur Insurance Management Services Claims Office

213 Smith Street
Dunmore, Pennsylvania 18512
(570) 969-4074 Fax: (570) 969-4172

Please note that a different adjustor may be assigned to your claim. The primary contact can also be the same for more than one line of business.

Obtain Your Claim Form Now

For your convenience, you may fill out the below form online and print it out in a completed state, or print the blank form to fill out by hand. Please note the law requires forms to be signed and faxed or mailed for your security and privacy.

Employer’s Report of Occupational Injury

Please call (570) 969-4074 for questions and to discuss your claim further.

For more information on HARIE, e-mail us at today or call (570) 344-1152.