Workers Compensation Claims Reporting

To report workers compensation claims select the link to the form for your appropriate state.  Complete the form and fax to (515) 295-4356.

 

Alabama	Kansas	North Dakota
Alaska	Kentucky	Oklahoma
Arizona	Louisiana	Oregon
Arkansas	Maryland	Pennslyvania
California	Massachusetts	Rhode Island
Colorado	Michigan	South Carolina
Connecticut	Minnesota	South Dakota
Delaware	Mississippi	Tennessee
District of Columbia	Missouri	Texas
Georgia	Montana	Utah
Hawaii	Nebraska	Virginia
Idaho	Nevada	Wisconsin
Illinios	New Hampshire
Indiana	New Mexico
Iowa	North Carolina