We've streamlined the question fields to only ask you what's truly important so you don't waste any time or have to track down obscure details. Of course, if you have additional information, you can definitely enter it to help us expedite the initial claim processing time.
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phone Call the 24 hour hotline
Dial 833-968-7642. We have trained personnel standying by around the clock to help you navigate an injury and record your claim.
computer Fill it out online
Click here to choose your state and access our online portal where you can fill out a report.
email Email a completed report
Email it to email@example.com. Whether you've filled it out by hand or via Adobe, if you have a completed report, you can email it to us.
print Fax a completed report
Fax it to 844-220-5070. If it's easier for you to scan and fax the completed report, it's good with us too.
Need to download the proper form for your state? Find your form by selecting your state here.