Workers Comp Claim Information

U.S. Highway 206 & Hills Drive

Monday-Friday 8am-8pm

Bedminster, New Jersey

Just minutes off of interstates 287 and 78

Sunday 9am-4pm

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Saturday 9am-5pm

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(908) 781-7171

Name of Claim Manager / Adjuster

Name of Worker's Compensation Insurance Company *

Email of Supervisor / Manager *

Thank you for entrusting Somerset Valley Urgent Care with your employee's healthcare needs. Our billing office is missing information needed to submit an insurance claim to your worker's compensation carrier. Please complete and submit the below information at your earliest convenience. You may also contact our billing office at 908-781-7171 or via email at billing@svurgentcare.com.

Please, DO NOT enter any protected private medical information!

Agency / Company Name *

Patient's (Employee) Name *

* indicates required field

Worker's Comp Claim Info

Agency / Company Mailing Address *

Additional Notes / Comments

Claim Submission Address

Phone and Extension of Supervisor / Manager *

Email Address of Claim Manager / Adjuster

Claim / Authorization Number

Phone and Extension of Claim Manager / Adjuster

Name of Supervisor / Manager *

Human Resource Contact (if applicable)

Date and Initial Work-Related Injury/Illness *

Just minutes off of interstates 287 and 78

Covid-19 Testing

Travel Vaccines

Call Us Today!

(908) 781-7171​

Somerset Valley Urgent Care

(908) 781-7171