The Report of Injury forms must be downloaded and completed immediately and sent to Insured Solutions via email or fax.
Our email address is: WCNewClaims@InsuredSolutions.net and our fax number is: 480-289-6220.
If you have any questions or concerns, please feel free to call Insured Solutions Claims department or Loss Control.
Claims email address: WCNewClaims@InsuredSolutions.net
Claims fax: 480-289-6220
Claims department: 480-376-0677
Loss control: 480-376-0677
Claims Reporting Procedures (English / Español)
Consent to Release of Medical Information (English / Español)
Employee Refusal of Medical Treatment (English / Español)
Employee Report of Injury form (English / Español)
Employer Report of Injury form (English / Español)
Workers' Compensation Claim Reporting Protocols (English / Español)
The forms noted above can be uploaded here or they can be emailed to WCNewClaims@InsuredSolutions.net.
To access additional information regarding claim reporting, please visit our risk management library here.