Report a Claim
If your employee suffers an injury while at work, time is of the essence. Report the claim within 24 hours of the injury.
Employer’s Report of Occupational Injury 5020 may be submitted by email, phone, fax, or mail.
- If reporting via telephone or online, the form will automatically be completed.
- If reporting via email or fax, complete the form to the best of your ability.
Claims Form: Employer’s Report of Occupational Injury 5020
- View the Claims Kit to access the Employer's Report of Occupational Injury or Illness and other state-specific claims information.
Report by Email
- Email your completed Form 5020 to reportaclaim@copperpoint.com
Report by Phone
- Call us at 800.231.1363
Report by Fax
- Fax your completed Form 5020 to 602.631.2888
Report by Mail
- Mail to: CopperPoint Insurance Companies, PO Box 36070, Phoenix, AZ 85067 or PO Box 33069, Phoenix, AZ 85067-3069
Pharmacy First Fill
The employee's first prescriptions are written by authorized workers’ compensation physicians for medications related to a workplace injury.
- A pharmacy first fill card is available to expedite care and ensure there are no out-of-pocket expenses.
Notification of Rights
The notification of rights is available in English and Spanish and is to be given to all injured employees. This document informs them on how to access medical care as well as their rights and responsibilities.
Medical Provider Network
To access our Medical Provider Network, please visit Find a Medical Provider.
OSHA Reporting Requirements
Employers may be required to report in a timely manner any injuries such as: in-patient hospitalizations, amputations, loss of an eye, fatalities or permanent disfigurement to OSHA.
- Please refer to OSHA for your specific jurisdiction requirements.
- It also is important to notify PacificComp at 866.374.8500 so the claim process can be initiated.