Report a claim, potential claim or grievance

Thank you for visiting our website and using WILMIC’s electronic submission form for reporting a claim, potential claim or grievance.  Your policy requires that you report claims or potential claims or grievances that you first become aware of during the current policy period in order to protect your insurance coverage for those matters.

Please provide the following information:                       

Your firm name: Please enter your firm name.
Your email address: Please enter your email address. Please enter a valid email address.
Name of lawyer(s) involved: Please enter at least one name.
Claimant/grievant name: Please enter a claimant/grievant.
Date of alleged error:
Date you first became aware of the matter:


Claimant/grievant’s description of complaint: (500 characters max.)

Your description of the matter: (500 characters max.)



Please verify the code above: Please enter the code shown.