Claims

REPORT A CLAIM

Alabama Self-Insured Worker’s Comp Fund

Any work-related injury should be reported immediately to Employer’s Claim Management, Inc., using the Employer’s First Report of Injury Form. For instructions, please review the Employer’s Guide for Reporting Workers’ Compensation Claims.  For detailed instructions and a sample policy/procedure, please review our Claim Reporting Procedure.

First Report of Injury Form

• First Report of Injury Form
• First Report of Injury Form – Instructions

Please fax or email your First Report Form to:

Employer’s Claim Management, Inc.
Fax: 334.240.2981
Email: firstreport@employersclaim.com

If the injury involves a fatality or catastrophic injury, call 1.800.392.1551

First Report of Injury – Electronic Submission Option
Claims may be submitted electronically through the CompInfoCenter.

CompInfoCenter

Other Forms

• Accident Investigation Form
• Employee Wage History
• Mileage Reimbursement Form
• WC Poster

 

Mailing Address

Employer’s Claim Management, Inc.
P.O. Box 5614
Montgomery, AL 36103-5614