Forms

From reporting an accident to enrolling in a medical provider network, this section offers policyholders and brokers the ability to easily get the information they need and effectively submit the required forms.

First-Fill Prescription: Allows injured workers to fill their first prescription without having to pay for it out-of-pocket and seek reimbursement later.

First Notice of Loss: Here you will find both the required USL&H form to meet federal requirements for claims made under the U.S. Longshore and Harbor Workers' Act (USL&H), as well as the required state forms for initiating claims.

Medical Provider Networks: Information about, enrollment in, and access to our local and national networks of carefully selected doctors.

ReadyReturn®: Strategies and forms for return-to-work programs that place injured employees in temporary work assignments to accelerate recovery and re-capture productivity.