Workers compensation and businessowners (BOP) claims forms
Select your claim type to find claims forms applicable in your state. When complete, fax them to us at 877-444-6806.
Workers compensation forms by state
ACORD Forms - Loss Notice, Notice of Occurrence, and First Report of Injury or Illness
ACORD 4 - Workers Compensation First Report of Injury or Illness (View instructions here)
ACORD 4WI - Wisconsin Employers First Report of Injury or Disease (View instructions here)