Barry D.

        Rosenberg, Inc.

  55 Old Turnpike Road
          Suite 508
          Nanuet, NY 10954




Claim Forms  Download

Auto Claims:  If you have an Automobile accident and have questions you may refer to the Auto Accident Information form.    New York State MV-104 Form required to be filed with DMV by all drivers involved in New York reportable motor vehicle accidents.

Homeowners Claims:  If you have an Homeowners claim and have questions you may refer to the Property Claim Information form. 

New York State Disability Benefits Claims: Available PDF Forms -NY DBL Claim Form   or 

Zurich Insurance Company Online Claim Reporting

  • Open the attached file and print it out. 

  • This printed form should be completed and signed by the employer, employee and the doctor, and mailed or faxed to us as soon as possible. If you have any questions in completing this claim form please feel free to call our office.

New York State Workers Compensation Claims (what to do when and accident happens)

The following c-2 form can be completed and either mailed or faxed back to our office.   New York Workers Comp Claim Form

Workers Compensation claim with the State Ins Fund

Claims can be reported online for the NY State Insurance Fund

Please Note: This form is in Adobe PDF format. To view or print PDF files from this web site, you must have an Adobe Acrobat Reader Version 4.0 or later. Download the FREE Acrobat Reader Now!

The form can now be completed on-screen. When the form appears on your screen, put the cursor in any fillable area and type. Tab from one fillable area to the next. For check boxes, put the arrow in the box you want to check and click the mouse once.

IMPORTANT: Two-sided forms are to be printed in duplex format and submitted to the Workers' Compensation Board on a single sheet. If this is not possible, submit only the front side of the form to the Board. Do not submit reverse on a separate sheet. Parties of interest other than the Board must receive both sides of all two-sided forms.


Travelers Launches Mobile Applications


Travelers Insurance has launched one of its first mobile applications: Auto Accident Help for iPhone and Quick Connect for BlackBerry smartphones. Both applications are free for anyone to download. Auto Accident Help is available at the iTunes store and Quick Connect is available on

While anyone can use these applications for auto accident assistance, Travelers customers will have the added advantage of being able to start the auto claim process directly through the iPhone application and the mobile Web site.

“Immediately after an accident, it is natural to feel unsure about what steps to take and we want to be there to help guide people through the process,” said Patrick Gee, Senior Vice President for Travelers Personal Insurance Claims. “Our new mobile applications allow us to do so by helping consumers with the necessary and important steps after an auto accident.”