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
Please submit your First Report Form by fax, email or Secure File Share:
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 Member Portal.
Other Forms
- Accident Investigation Form
- Employee Wage History
- Mileage Reimbursement Form
- WC Poster
- Refusal of Medical Treatment
Mailing Address
Employer’s Claim Management, Inc.
P.O. Box 5614
Montgomery, AL 36103-5614