Please Report all claims within 24 hours.
Fraud Reporting: 1-800-944-FRAUD Anonymous tip-line
- Take care of the employee. If the injury is an emergency, dial 911.
- Report the claim within 24 hours:
By WEB (on-line):
New claim? Click here to report.
By email: ClaimsExpress@accidentfund.com
By fax: 866.814.5595
By telephone: 866.206.5851
Gather the information below before reporting the claim. We'll help you select the best medical care provider. We'll work with you, the medical provider and your employee to help ensure a safe return to work whenever possible. The claim will be filed with the appropriate regulatory authority for you, if necessary.
- State of injury
- Employer name
- Accident Fund policy or account number
- Employees supervisor name and phone number
- Claim reported by who; job title; phone number
- Location of injury (if employer has multiple locations)
- Date accident was reported to employer
- Date of injury; time of injury
- Last day worked
- Employee name
- Employee full name; address; phone number (home and work)
- Employee gender
- Employee social security number
- Employee date of birth
- Employee occupation
- Employee date of hire
- How did accident occur? Description
- Type of injury (i.e., broken? Sprain?)
- Body part injured
- Will employee be off work? Expected return to work date
- Was injury fatal?
- Employee ability to return to work? Actual return to work date
- Was employee referred for care? Where? (phone number)
- Communicate with the employee. Show you care by sending cards and calling to see how he or she is recovering. Let the employee know you value their work and want to see them back as soon as possible.
Our main office will be closed to observe the following holidays in 2014:
New Year's Day
Wednesday, January 1
Martin Luther King, Jr. Day
Monday, January 20
Friday, April 18
Monday, May 26
Friday, July 4
Monday, September 1
Thursday, November 27
Friday, November 28
Wednesday, December 24
Thursday, December 25
New Year's Eve
Wednesday, December 31