Report a Claim

Please submit your claim electronically by following the instructions below.

  1. Select the State in which the injury occurred below.
  2. Enter information directly into our 6-Step online First Report Of Injury (FROI) form.
  3. 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”