Report an Auto and General Liability Claim

These services are available to all MCSIP members except Fire & Rescue Services and City of Gaithersburg.

For Auto and General Liability claims, you can use e-mail, fax or telephone to report a claim. Before using any of the methods, make certain you have the following information:

Standard Report Information

  • Agency name, address and location code
  • Claimant information, please include phone number and address
  • Date the accident occurred
  • Location of the accident and any witnesses
  • Date and time client was notified of the incident
  • Any additional relevant information

Click to view the Location Code Directory.

Motor Vehicle and Liability Accident Notice Form | Download here

This form is designed to help you document all of the necessary facts of a liability or automobile accident. This form should be used by Program Supervisory Personnel only. Once completed please follow Reporting Methods and submit by email or fax.

Reporting Methods

E-Mail

Claims can be sent via e-mail to fnol_fax@corvel.com. You must follow these procedures when sending:

  1. In the Subject Line you MUST have: Montgomery County MD Self Ins Liability
  2. In the Body of the e-mail, include the standard report information above
  3. Provide your name and phone number

Fax

Fax the report to 866-777-1668. If reporting by fax, please include the fax cover sheet.  Download Liability Fax Cover Sheet. Make sure the items you are faxing are clear and legible. The first report representative will receive your fax and submit the results electronically to the handling MCSIP claim office.

Telephonic

Call 888-606-2562.The phone will be automatically answered “Montgomery County Self Insurance Program, first report of injury.” A telephonic first report representative will receive your call and prompt you through the questions necessary to complete the report.

Care MC Liability Claim Receipt Report

Learn how to locate general liability, automobile liability, and property damage claims in CareMC | Download CareMC Liability Claim Receipt Report User Guide

Questions? Call MCI at (703) 817-0407.