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Claims Forms
These forms are in MS Word format. To download, right-click and pick the "Save target as..." option.
Arizona Employer's Report of Injury
California Employer's First Report of Occupational Injury or Illness - 5020
California Workers' Compensation Claim Form (DWC 1)
Florida First Report of Injury or Illness - DWC
Nevada C-3 (Employer's Report of Accident)
Toll-free claims numbers
Auto: 877.849.4678
Non-auto: 877.4 ICW NOW
(877.442.9669)