Insured Solutions
Insured Solutions

The Report of Injury forms must be downloaded and completed immediately and sent to Insured Solutions via email or fax.

Our email address is: 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:

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

To access additional information regarding claim reporting, please visit our risk management library here.