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Home » Express Request Service Center

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.)