All Other Claims
Remember to protect your property to prevent any further damage and contact us any of the following ways:
REPORT BY PHONE: (800) 825-9489
Please have your policy number and name of insured/policyholder as named on the policy.
Please have the following claimant information:
Full name, age, date of birth, social security number
Date/hours of employment and wages
Date, time and location of injury
Home address and phone number
REPORT BY E-MAIL: [email protected]
REPORT BY FAX: (855) 603-8409 (Yep, we can still do that!)
Email or fax your completed State Workers’ Compensation First Report of Injury form.
Fraud Statement – Applicable in All States:
Any person who knowingly and with intent to defraud any insurance company or other person, files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and subjects the person to criminal and civil penalties.