If you wish to report a Workers’ Compensation claim, do not report using the online form. State statutes require that Workers’ Compensation claims be reported with a First Report of Injury. To report a Workers’ Compensation claim, please select from the following state list to be directed to the applicable State’s First Report of Injury. Complete the form and submit to firstname.lastname@example.org or fax to 505.247.8540.
For all other claims, you can start the process online by filling out the form below.