Managing Insurance Portfolio
Since 1902

Workers’ First Report of Injury Form

Please print the Workers’ Compensation First Report of Injury form, fill out all applicable information and fax to 601.833.3409. Please note that all required(*) fields must be filled out.

WC First Report of Injury Form (28KB PDF)

Managing Insurance Portfolio Since 1902

Workers’ First Report of Injury Form

Managing Insurance Portfolio
Since 1902