Workers' Compensation Application and Submission

To submit an application, please send

Completed ACORD 130 App
Number of employees by location
Supporting Glatfelter lines of insurance required, with the exception of monoline coverage
Glatfelter Healthcare Workers' Compensation App for Hospice and Home Healthcare OR Senior Living
5 years of currently valued loss runs (including loss details of any loss $25,000+)

Send all Workers' Comp submissions here.

Download the Hospice and Home Healthcare application

Download the Senior Living application

To submit an application, please send:

Completed ACORD 130 App
Number of employees by location
Supporting Glatfelter lines of insurance required, with the exception of monoline coverage
Glatfelter Public Entities Workers' Compensation App for Water/Water Related Districts and Miscellaneous Public Entities OR Educational Institutions
For Water/Water Related Districts and Miscellaneous Public Entities — 5 years of currently valued loss runs (including loss details of any loss $10,000+)
For Educational Institutions — 5 years of currently valued loss runs (including loss details of any loss $25,000+)

Send all Workers' Comp submissions here.

Download the Education application

Download the Water/Water Related Districts and Miscellaneous Public Entities application

THANK YOU FOR YOUR INTEREST!