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REPORT A CLAIM FORMS CONTACTS |
Report a claim BY WEBSITE Complete a First Report of Injury Form, then upload:
Secure uploadBY EMAIL
Complete a First Report of Injury Form.
BY FAX
Complete a First Report of Injury Form.
BY PHONE
Simply call 800-234-8242 and advise that you are reporting a claim.
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REPORT A CLAIM FORMS ARKANSAS SOUTH CAROLINA TENNESSEE TEXAS CONTACTS |
Forms Arkansas EMPLOYER
First Report of Injury or Illness (FORM-1) South Carolina EMPLOYER
First Report of Injury or Illness (FORM-12A) Tennessee EMPLOYER
First Report of Injury or Illness (DWC FORM-C20) Texas EMPLOYER
First Report of Injury or Illness (DWC FORM-001) EMPLOYEE
Employee’s Claim for Compensation (DWC FORM-041) |
REPORT A CLAIM FORMS CONTACTS |
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