Agents

Information needed to report a claim

We are happy to fill out the proper forms needed and submit the claim. Call 800.374.4990
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When you call our workers’ compensation claims customer service number, make sure that you have as much of the following information as possible. While this information is not needed to initiate a claim, we will ask you for this information at some point so we can better manage the claim.

Employee Information

  • Employee’s name, address and phone number
  • Employee’s job description
  • Employee’s Social Security number
  • 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
  • Employee’s medical status and physician/hospital name

Employer & Accident Information

  • Policy number
  • Employer’s name and address
  • 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
  • Name of person calling in the report
  • Return-to-work date

Report Workplace Injuries

Call 800-374-4990 or report online.

What To Do Next

Creating A Modified-Duty Program

It takes five simple steps to create an early return-to-work program.

Learn More

Finding Light-Duty Tasks

Identify tasks before a workplace injury.

Learn More