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 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

Secure File Share

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.

Portal Login

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