Express Request Service Center

General Service Forms

Specialty Program Forms

Workers Compensation Report of Injury

  • Report of Injury Form
  • (If you are reporting an injury for an injured worker and you have Workers Compensation coverage with us, you will need to complete the Employer Report of Injury Form. Click on the link above and complete the form to Submit the notice to us. You will also be given a copy of the completed form as well.)


Have Questions?
Need more information about Hill & Usher or one of our programs? Contact one of our licensed insurance professionals by phone or email for assistance.
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Richard B. Usher,
Agency Principal
Hill & Usher
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Phone: (602) 956-4220 | Fax: (602) 956-4418