Information Needed to Report A Claim

We are happy to fill out the proper forms needed and submit the claim.

Calling our Workers' Compensation claims customer service number is the fastest and easiest way to file a claim.

Experienced staff are ready to complete the necessary form for you or your policyholder and file it electronically. Plus, we'll make sure that the form is sent to all required recipients: NCIC, the agency, employer, employee and KeyScripts.


Another important benefit is that you immediately obtain a claim number, which is needed by medical offices when an employee receives treatment. Not having a claim number could delay medical treatment for the employee.

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