Program Services » Report a Claim – Employer Initial Report Form     Wednesday, September 20, 2017    
 Employer Initial Report Form
In order to assist ERMA in monitoring claims and maintaining reserves for cases that fall within its purview, please download & fill out the following form to the left for each claim or occurrence that is required to be reported to ERMA. Please answer each item as completely as possible with the information available to you. Use additional sheets as necessary. 
 
Initial Claim Report - click here 
 
Please attach to this form a copy of all Governmental Tort Claim, DFEH and/or EEOC documents you have regarding this claim or occurrence.
 
Assignments to defense counsel will be made through ERMA after consultation with the ERMA member.
 
If you have any questions, please call Kathy Maylin, Litigation Manager, at (800) 541-4591 ext. 19181, or Lance Gerber, Legal Analyst, ext. 19039.
  
 Contact / Submittal Info

Please submit information to:

Lance Gerber, Legal Analyst info@ermajpa.org

  
Employment Risk Management Authority / 1750 Creekside Oaks Drive, Suite 200 / Sacramento, CA 95833 / Toll free: (800) 541-4591 / Fax: (916) 244-1199
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