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How to file a claim

Frequently asked questions about claims

Call the dedicated toll-free hotline (800) 626-8381 to report a claim.

Choose your Worker's Compensation insurance carrier and follow the instructions below. 

Amerisafe:

ICW Group:

  • File a claim online and select the state in which the claim occurred

PIE Insurance:

Pinnacol:

Protective Insurance:

Saif:

Texas Mutual:

Vanliner:

Follow the steps below:

  1. Download this form.
  2. Fill in the required information.
  3. Attach the form to an email.
  4. Attach the Demand letter, EEOC charge notification, Summons, Complaint, Administrative Agency Charge or similar document to the email as well.
  5. Send the email to the address listed within the form.

That's it! 

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