Report a claim

Please report ALL injuries and incidents
in 24 hrs, including 911 emergencies

If this is an emergency

Call 911

or continue to

Report a claim

Option 1

Injured employee

Speak with a nurse and report a claim

Learn more

What to expect for a nurse triage call

  • Record the call
  • Reassure the employee
  • Triage the injury
  • Coordinate the referral to the physician
  • Report the injury or incident, create the claim

Option 2


Report a claim

Report checklist

Report checklist

Employer Info

  • Company DBA
  • Company Legal Name

Injured Employee Info

  • Full name
  • Address
  • Phone number
  • Date of birth
  • Date of hire
  • Social security number
  • Occupation/role
  • Full-time or part-time
  • Weekly wages or salary

Injury Details

  • Specific injury and body part
  • Date and time of injury
  • Location where injury occurred
  • Activity being performed when injury occurred
  • Time employee began work the day injury occured
  • Date last worked
  • Date returned to work