Downloadable Forms
Forms
Below are forms and information packages that will be useful as we begin, and continue, our working relationship together:
- TPA Questionnaire
- Pan American Disclosure Statement
- Chubb(Federal) Disclosure Statement
- Specific Reimbursement Request Form
- Specific Stop Loss 50% Notification Form
- Aggregate Submission Form
- Claim Notice & Filing Procedures.doc
- Specific Claim Submission Checklist
- Pre-screen Checklist (excel spreadsheet)
For more information, please contact us.
News & Events
- January 1, 2010
East Coast Underwriters Announces Partnership with Niagara Re - July 1, 2008
ECU adds Starr Global Accident & Health Insurance Agency, LLC - May 12, 2008
Mike Hirsch Joins ECU as VP of Sales - January 1, 2007
ECU and Pan-American Announce New “Spaggregate™” Product - October 31, 2006
Halloween party photo gallery - April 25, 2005
ECU adds Pan American Paper
Downloadable Forms
Forms and information packages available online — click here.
Spartanburg SC 29306
Phone: (864) 542-1565