Forms and reporting deadlines differ by jurisdiction, as workers’ compensation insurance statutes differ state to state. For that reason, you may need to ask your agent or adjuster for the precise information you might need in your respective state.
If your employee suffers an injury while at work, an industrial injury report must be filed with CopperPoint and in accordance with the respective state. To access the proper form, click on the state.
How do I file a workers’ comp claim electronically?
You can log in by clicking here if you have registered previously to complete the process of filing the claim online.
If you have not registered your CopperPoint account and policy, you can reference our FAQs, which will explain the registration process and allow you to take advantage of filing the claim one online.
What other ways can I file a workers’ comp claim?
- The form can be submitted to CopperPoint via email to ReportaClaim@copperpoint.com or by U.S. mail. The employer should complete the industrial injury form, not the employee.
- Each state has its own regulations relative to a filing deadline. To provide efficient, appropriate service, and to contain costs, the industrial injury form should be filled out and filed accurately as soon as possible.
- Employers are required to report all in-patient hospitalizations, amputations or loss of an eye to the Occupational and Safety Administration (OSHA), or the state’s equivalent agency. It also is important to notify CopperPoint at 1.800.231.1363 so the claim process can be initiated.
- Provide the employee with the Script Advisor Workers’ Comp First Fill Prescription Card, so he/she can fill the initial prescription related to the industrial injury.
- When we receive the industrial injury report, we will review the information, investigate and make a decision regarding the claim.
- In the unfortunate event that a fatality occurs, the incident must be reported with 8 hours to OSHA, or the state’s equivalent agency. Other state departments may also need to be contacted, and it is important to notify CopperPoint at 1.800.231.1363 so the claim process can be initiated.
If you are a medical provider, please complete the proper form for your state and have the injured worker sign it. The completed and signed document should be mailed within the state’s reporting guidelines. Be sure to fill out the form completely.
Please include your physical address, not a Post Office Box number.
The mailing address for medical bills from Arizona, Colorado, New Mexico and Utah is:
CopperPoint Insurance Companies
Mail Stop: WCS 135801
PO Box 2979
Clinton, IA 52733-2979
The mailing address for the Nevada C-4 Form: Employee’s Claim for Compensation/Report of Initial Treatment is:
CopperPoint Insurance Companies
PO Box 33657
Las Vegas, NV 89133
- Immediately notify your employer of the workplace accident, injury or industrial illness. The employer will complete an industrial injury report.
- Ask your employer for a referral to a physician or medical facility, or view CopperPoint's workers' compensation preferred network directory.
- Upon arrival at the medical facility, complete and sign the Worker's and Physician's Report of Injury form. Your medical provider should have this form available.
- Ask the physician to immediately send the reports to the Industrial Commission of Arizona and to CopperPoint so your workplace injury compensation claim may be filed.
- Complete and immediately return all requests for information about your workplace injury claim.
- Complete the Workers Report of Injury and Release of Medical Information (407) form and return it to CopperPoint via mail or fax.