Does the injury involve any of the following?
If YES, please call 1.800.442.0593 immediately to report the injury.

  • Hospitalization longer than 3 days OR admission to ICU
  • Fatalities
  • Burns requiring admission to a burn unit
  • Head injury
  • Spinal cord injuries
  • Amputation at or above a hand or foot, of three or more fingers on same hand, or of a major limb
  • Significant crush injury to a major limb or body part
  • Two or more fractures of limbs
  • Occupational disease due to toxic substance (e.g. asbestosis, mesothelioma)
If NO, choose from one of these reporting options.

File an eClaim. Get started. >

Submit a claim over the phone.
Call 1.800.442.0593.

Submit a claim through your online account.
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Fax your claim form: 1.800.442.0597.
Visit our virtual claims kit to download the state-specific First Report of Injury form.