File A Claim Online

Please note: our digital customer portals are not yet online.

  • Policy number
  • Claim reported by: name, job, title, phone
  • Date of accident
  • Employee’s full name, address, phone
  • Employee’s social security number
  • Employee’s hire date and date of birth
  • Employee’s last day of work
  • Expected return-to-work date
  • Type of injury
  • Details on how the accident happened
  • Date the injury was reported to employer
  • Business location where the employee works
  • Employee’s supervisor’s name and phone

To ensure prompt processing, please file your claim within 24 hours of when an injury occurs.

Essential Claim Process Information

We do our best to help you ensure accidents don’t happen. However, when they do, we’ll be there to guide you. To gain a better understanding of the claim process and how we support you throughout it, click the link below:

CLAIM QUICK STEP GUIDE

CLAIM QUICK STEP GUIDE – Spanish

How to Report a Claim How to View Claims
Other options for filing claims
Please note that all of the information listed above is needed when filing a claim through any of the below options.

Call us: 888-709-3651

Email your claim information: [email protected]

517-316-2747; 866-814-5595

First Report of Injury Form 5020

Employee’s Claim for Workers’ Compensation Benefits DWC-1

Claims outside of California:
Send a fax: 866-835-5331
Email: [email protected]