Report a Workers' Compensation Claim

We're sorry that you have experienced a claim.

Please try to complete the fields on the pages below as thoroughly as you are able so that we can better assist you.
If you prefer to notify us of your claim by phone, please call us at 888.701.1896. Staff is available 24 hours every day to help.

Note: Asterisks (*) indicate required fields. Use built-in navigation buttons to avoid loss of data.

Note: The Insured is the organization for which the insurance policy relating to this claim was issued. If you are an injured worker, the Insured is your employer.
Insured Contact Information
Employment Information
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