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Injury information for workers' compensation claims
While we don’t need this information to initiate a claim, we will ask you for this information at some point so we can help manage the claim:
  • Employee’s name, address, phone number and job description
  • Employee’s Social Security number
  • Employer’s name and address
  • Employee’s date of birth, marital status and number of dependents
  • Employee’s length of employment
  • Employee’s gross weekly salary and weekly work hours
  • Names of witnesses or first person to arrive at the scene of the accident/injury
  • Date, time and place of accident
  • Complete description of the accident
  • Complete description of the injury
  • Employee’s medical status and physician/hospital name
  • When the employee returns to work
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