1. Company Name and your policy number.
2. Description, date, and time of the incident.
3. Injured employee’s name, address, Social Security number, date of hire, occupation, wages, and date of birth.
4. If the employee received medical attention for the injury prior to your call, the name, address, and phone number of the medical provider.
Once we receive the claim, we can also answer any questions you or your employer may have about workers’ compensation processes and benefits
Report by phone: 1-877-223-4437
Report by email: firstname.lastname@example.org
Report by fax: 1-800-889-9898
Provide all the information listed above.