Report A Workers’ Compensation Claim

First Report of Injury

Additional Claim Forms

  • C11 – Employer’s Report of Injured Employee’s Change in Employment Status Resulting from Injury
  • C240 – Employer’s Statement of Wage Earnings
  • C-107 – Employer’s Request for Reimbursement

Information for your employee

Subscribe

 

Join our mailing list!

Complete the short form below to join our mailing list.