In order to submit your claim electronically, please follow the instructions below.
- Select the State in which the injury occurred by clicking on the map ordrop-down.
- Enter information directly into the First Report Of Injury (FROI) form.
- Once you’ve completed the information save the document, either by clicking the Save icon or selecting File on the menu and Save As to name the file as you wish.
- Submit the completed FROI to the email address or fax number shown below.
Please select your state:
or click your state on the map
Claim Reporting Options