Workers Compensation First Notice of Loss

This kit is provided to new workers’ compensation policyholders and their agents, as well as to all current policyholders when their policies renew. It contains important claims department contact information, instructions, and forms. Use of the forms available on this site are intended for the exclusive use of our policyholders and their agents.

Note: Enter the Injured worker’s legal name on the injury reports as it appears on their social security card as well as their social security number. This information is required as per Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007.

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