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Williams & Partners

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Submit a Claim

To submit a new claim to Williams Meaden & Moore, please fill out the online form below or email us directly with your new claim referral at: claims@wmmi.ca

I understand the Terms of Use * Required Field

Company Information

* Company Name * Name of Adjuster

* Telephone Fax

* Email

Claimant Information

* Policy/Claim Number * Date of loss

* Claimant Name Telephone

Address City

Province Postal Code

* Date of birth

Representation

* Indicate type of representation Legal representationNon-legal representationNo representation

Relationship

Contact Name Firm Name

Address City

Province Postal Code

Telephone Fax

Email

Additional Information

Claim Type ABTortOther

Other

Policy Details

Optional benefits purchased: None6008001000

Income Replacement Benefits paid to date? YesNo

If yes, what is the amount paid to date?

Collateral benefits available? YesNo

Documentation Received (please forward to us) Application for Accident Benefits (OCF-1)Employer's Confirmation of Income (OCF-2)Claimant's Signed Statement

Financial documentation (please list): Other documentation (please list): Comments

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Caution: Do not use the “Submit a Claim” interface to send any privileged or confidential information. Internet messages can be intercepted.

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675 Cochrane Dr., East Tower
Suite 505 Markham
ON L3R 0B8

Toll-Free: 1-855-888-9937
Email: claims@wmmi.ca
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