Report a Claim
Please submit your claim electronically by following the instructions below.
- Select the State in which the injury occurred below.
- Enter information directly into our 6-Step online First Report Of Injury (FROI) form.
- Once you’ve completed our online form and submitted your information, you may save the newly created PDF document for your records by clicking the “Download PDF” link then selecting “File > Save As” in your browser’s menu bar.
Please select your state:
Please CLICK HERE if you have further questions about how to report an “On-the-job Injury”