Report a Workers' Compensation Claim

You expect your insurance company to respond quickly when your employee needs to file a claim. That's why our experienced workers' compensation claims staff is always ready to assist you and your employee during the entire claims process.

To report a claim, choose from our 4 easy methods below:

1. Call us

877.4 ICW NOW - or 877.442.9669.

2. Fax us

858.436.8916

3. Mail

First Notice of Loss
P.O. Box 85563
San Diego, CA 92186-5563

4. Email us

Contact us at firstnotice@icwgroup.com.

Use one of these forms

To use forms, download to your desktop before completing (right-click and pick the "Save target as..." option).

• Arizona Employer's Report of Injury (MS Word)
• California Employer's First Report of Occupational Injury or Illness - 5020 (MS Word)
• California Workers' Compensation Claim Form (DWC 1) (PDF)
• Florida First Report of Injury or Illness (DWC 1) (PDF)
• Illinois Form 45: Employer's First Report of Injury (PDF)
• Nevada C-3 (Employer's Report of Accident) (PDF)