File A Claim

Report a new workers’ compensation claim immediately. Early, appropriate delivery of healthcare is critical in effectively managing lost workdays and medical costs.

Claims can be reported 24/7 using any of the following methods:

  1. Call our Clinical Consultation service at 866.764.7705 to receive immediate care recommendations from an occupational nurse, directions to your local preferred medical provider and complete your first notice of injury (FNOI).
  2. Complete the online form below and submit through the website.
  3. Complete the Standard Intake Form and fax or email to the contact info at the top of the form.

Learn more about the Clinical Consultation services offered exclusively to policyholders of Retailers Insurance Company by clicking here.

Serious injuries or death claims
Report serious injuries and death claims immediately, by phone, to Sedgwick. In the event of a death, employers must also notify the state within 8 hours by calling 800.858.0397. If a work-related inpatient hospitalization, amputation or eye loss occurs, employers must notify the state within 24 hours by calling 844.464.6742.

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