Arizona
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
CopperPoint/Alaska National portals will be down for maintenance Friday, May 2nd at 5:00 p.m. PDT, until Monday, May 5th at 7:00 a.m. PDT.
Claims Kit
When it comes to the complexities of workers’ compensation, you can rely on our deep expertise to help you navigate specific state regulations and claims forms. These resources provide the valuable information and tools you need when dealing with a workplace injury.
For help identifying your insurance company, please contact us at 800.231.1363.
Your Claims Kit will include:
- State Forms
- Posters & Brochures
- State Compliance Information
- Injured Worker Resources
- Documents Provided by CopperPoint, Alaska National and PacificComp
Colorado
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
New Mexico
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Utah
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Nevada
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Alabama
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Alaska
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Arkansas
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
California
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Connenticut
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Delaware
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Florida
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Georgia
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Hawaii
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Idaho
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Illinois
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Indiana
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Iowa
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Kansas
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Kentucky
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Louisiana
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Maine
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Massachusetts
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Maryland
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Michigan
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Minnesota
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Mississippi
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Missouri
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Montana
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Nebraska
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
New Hampshire
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
New Jersey
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
New York
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
North Carolina
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
North Dakota
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Ohio
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Oklahoma
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Oregon
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Rhode Island
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Pennslyvania
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
South Carolina
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
South Dakota
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Tenneessee
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Texas
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Vermont
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Virginia
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Washington
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
West Virginia
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Wisconsin
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Wyoming
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Washington, D.C.
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Alabama
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Arizona
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Arkansas
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Alaska
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
California
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Colorado
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Connenticut
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Delaware
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Florida
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Georgia
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Hawaii
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Idaho
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Illinois
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Indiana
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Iowa
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Kansas
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Kentucky
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Louisiana
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Maine
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Massachusetts
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Maryland
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Michigan
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Minnesota
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Mississippi
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Missouri
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Montana
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Nebraska
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Nevada
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
New Hampshire
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
New Jersey
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
New Mexico
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
New York
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
North Carolina
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
North Dakota
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Ohio
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Oklahoma
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Oregon
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Pennslyvania
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Rhode Island
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
South Carolina
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
South Dakota
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Tenneessee
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Texas
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Utah
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Vermont
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Virginia
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Washington
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
West Virginia
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Wisconsin
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Wyoming
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Washington, D.C.
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Arizona
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Alabama
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Alaska
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Arkansas
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
California
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Colorado
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Connenticut
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Delaware
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Florida
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Georgia
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Hawaii
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Idaho
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Illinois
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Indiana
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Iowa
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Kansas
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Kentucky
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Louisiana
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Maine
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Massachusetts
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Maryland
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Michigan
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Minnesota
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Mississippi
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Missouri
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Montana
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Nebraska
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Nevada
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
New Hampshire
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
New Jersey
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
New Mexico
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
New York
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
North Carolina
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
North Dakota
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Ohio
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Oklahoma
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Oregon
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Pennslyvania
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Rhode Island
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
South Carolina
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
South Dakota
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Tenneessee
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Texas
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Utah
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Vermont
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Virginia
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Washington
Claims Kit Contents
CopperPoint Insurance Company
PO Box 36070
Phoenix, AZ 85067
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
West Virginia
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Wisconsin
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Wyoming
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Washington, D.C.
Claims Kit Contents
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com
Forms
Fatality Report
Required
Notice of Employee Death
Required
Report of Injury or Illness
Required
Supplemental Report of Injury
Required
Posters and Brochures
OFFICIAL NOTICE Panel of Physicians
Required
Employee Rights and Duties form
Required
Notice of Reported Injury
Required
OFFICIAL NOTICE WC/MCO Panel
Required
POSTER - Anti-Fraud Poster
Required
POSTER - Bill of Rights
Required
POSTER - Bill of Rights - (Spanish)
Required
POSTER - Drug Free Workplace
Required
POSTER - Fraud Poster
Required
POSTER - Informational Poster
Required
POSTER - Job Safety and Health
Required
POSTER - Job Safety and Health Law
Required
POSTER - Labor Law
Required
POSTER - Labor Law (Spanish)
Required
POSTER - Notice for Employees Poster
Required
POSTER - Notice of Coverage
Required
POSTER - Notice to Employees
Required
POSTER - Notice to Employees
Required
POSTER - Notice To Employees Poster
Required
POSTER - Poster of Instructions
Required
POSTER - Posting Notice
Required
POSTER - Safety on the Job Poster
Required
POSTER - WC Act Summary
Required
POSTER - WC Act Summary Spanish)
Required
POSTER - Workers' Compensation
Required
POSTER - Workers' Compensation
Required
POSTER - Workplace Notice
Required
POSTER - Workplace Notice (Spanish)
Required
Poster Regulations
Required
Statement of Rights (WCL)
Required
WCA - POSTER - 11 x 17 version
Required
WCA - POSTER - Fraud Poster
Required
State Compliance Information
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Penalties for Late Reporting
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Physician Selection
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Posting Requirements
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Reporting of Claim by Employer
Documents Provided by CopperPoint
After you complete the Employer's Report of Injury form, located in the forms section above, please submit the form via your CopperPoint portal or email it to reportaclaim@copperpoint.com. CopperPoint will forward a copy of your report to the Industrial Commission of Arizona (ICA) on your behalf.
- NEW 1/27/25 Arizona: Workers Report of Injury
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Worker's Report of Injury and Release of Medical Authorization
(to view and download, right mouse click on the link, select "save link as") - Medical Authorization Form
- Wage Form
- Travel Reimbursement - English
- Travel Reimbursement - Spanish
- Change of Address
- Witness Statement
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
- Return To Work Transitional Employment Offer Template
- Return To Work Transitional Employment Offer Template - Spanish
- Return To Work Policy Guide
Injured Worker Resources
Medical Provider Required Information
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.
Medical Provider Billing Information
The mailing address for medical bills from Arizona, Colorado, New Mexico, Nevada, and Utah is:
CopperPoint Insurance Companies
PO Box 3477
Portland, OR 97208-3477
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Medical Records Release
- Travel Reimbursement
- Change of Address
- Witness Statement
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
The mailing address for medical bills from Arizona, Colorado, New Mexico, Nevada, and Utah is:
CopperPoint Insurance Companies
PO Box 3477
Portland, OR 97208-3477
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Medical Records Release
- Travel Reimbursement
- Change of Address
- Witness Statement
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
The mailing address for medical bills from Arizona, Colorado, New Mexico, Nevada, and Utah is:
CopperPoint Insurance Companies
PO Box 3477
Portland, OR 97208-3477
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Travel Reimbursement
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
The mailing address for medical bills from Arizona, Colorado, New Mexico, Nevada, and Utah is:
CopperPoint Insurance Companies
PO Box 3477
Portland, OR 97208-3477
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Designated Provider List - Nevada
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Injured Employee's Request for Compensation (D-6)
- Mileage Form D-26
- Change of Address
- Witness Statement
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
The mailing address for medical bills from Arizona, Colorado, New Mexico, Nevada, and Utah is:
CopperPoint Insurance Companies
PO Box 3477
Portland, OR 97208-3477
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
- California SB 1159
- California, Go-Forward COVID-19 Employer Reporting Form
- Predesignation of Personal Physician
- Notice of Personal Chiropractor or Personal Acupuncturist
Return To Work
- Return To Work Transitional Employment Offer Template - English
- Return To Work Transitional Employment Offer Template - Spanish
- Return To Work Transitional Employment Offer Template - Spanish " rel="noopener" target="_blank">Return To Work Transitional Employment Offer Template - Spanish
- Return To Work Policy Guide
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- C-105 Form Required
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Bona Fide Job Offer
- Travel Reimbursement
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- DWC074 – Description of Injured Employee’s Employment
- DWC073 – Texas Workers’ Compensation Work Status Report
- DWC048 – Request to get reimbursed for travel costs
- Bona Fide Job Offer
- Texas Bona Fide Job Offer – Temporary Alternative Duty (BFJO) document added. -Per Rule 129.6, for the Bona Fide Job Offer to be valid a DWC073 (filled out by doctor) must be attached to the offer. (Blank DWC073 included for reference)
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by CopperPoint
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Medical Provider Required Information
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.
Medical Provider Billing Information
Please direct all CopperPoint billing questions and inquiries to our medical bill review partner CorVel Corporation at 916-605-5140 or Email: Medcheck_48@corvel.com.
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish 1
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Return To Work
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Workers Compensation Injury Reporting Procedures Rev 06_2016
- AK Employer Supervisor Notice of Occupational Injury or Illness
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
- Longshore, Employer's First Report of Injury or Occupational Illness - LS-202
Return To Work
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Wage Statement
- Authorization To Release Personal Health Information
- Workers' Compensation Fraud Poster - English
- Workers' Compensation Fraud Poster - Spanish
- Workers' Compensation Fraud Poster - Chinese
- MPN Employee Guide (Covered Employee's Notification of Rights) - English - Required
- MPN Employee Guide (Covered Employee's Notification of Rights) - Spanish - Required
- Employee Medical Care Declination - English/Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
- California SB 1159
- California, Go-Forward COVID-19 Employer Reporting Form
- Predesignation of Personal Physician
- Notice of Personal Chiropractor or Personal Acupuncturist
- Longshore, Employer's First Report of Injury or Occupational Illness - LS-202
Return To Work
- Return To Work Transitional Employment Offer Template - English
- Return To Work Transitional Employment Offer Template - Spanish
- Return To Work Transitional Employment Offer Template - Spanish " rel="noopener" target="_blank">Return To Work Transitional Employment Offer Template - Spanish
- Return To Work Policy Guide
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
- Longshore, Employer's First Report of Injury or Occupational Illness - LS-202
Return To Work
- Return To Work Transitional Employment Offer Template - English
- Return To Work Transitional Employment Offer Template - Spanish
- Return To Work Policy Guide
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
- Return To Work Transitional Employment Offer Template - English
- Return To Work Transitional Employment Offer Template - Spanish
- Return To Work Policy Guide
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
- Return To Work Transitional Employment Offer Template - English
- Return To Work Transitional Employment Offer Template - Spanish
- Return To Work Policy Guide
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
- Return To Work Transitional Employment Offer Template - English
- Return To Work Transitional Employment Offer Template - Spanish
- Return To Work Policy Guide
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
- Return To Work Transitional Employment Offer Template - English
- Return To Work Transitional Employment Offer Template - Spanish
- Return To Work Policy Guide
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Designated Provider List - Nevada
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
- Return To Work Transitional Employment Offer Template - English
- Return To Work Transitional Employment Offer Template - Spanish
- Return To Work Policy Guide
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
- Return To Work Transitional Employment Offer Template - English
- Return To Work Transitional Employment Offer Template - Spanish
- Return To Work Policy Guide
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
- Return To Work Transitional Employment Offer Template - English
- Return To Work Transitional Employment Offer Template - Spanish
- Return To Work Policy Guide
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by Alaska National
- C-105 Form Required
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by Alaska National
- Bona Fide Job Offer
- Travel Reimbursement
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Majoris OR MCO Employee Enrollment Packet
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by Alaska National
- DWC074 – Description of Injured Employee’s Employment
- DWC073 – Texas Workers’ Compensation Work Status Report
- DWC048 – Request to get reimbursed for travel costs
- Bona Fide Job Offer
- Texas Bona Fide Job Offer – Temporary Alternative Duty (BFJO) document added. -Per Rule 129.6, for the Bona Fide Job Offer to be valid a DWC073 (filled out by doctor) must be attached to the offer. (Blank DWC073 included for reference)
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
- Longshore, Employer's First Report of Injury or Occupational Illness - LS-202
Return To Work
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by Alaska National
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- 24/7 Injury Helpline FAQ
- 24/7 Injury Helpline Poster English/Spanish
- 24/7 Injury Helpline Overview
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Consumer Privacy Statement
Return To Work
Documents Provided by PacificComp
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Medical Records Release of Injured Worker
- Wage Statement
- Mileage Form
- Fraud Poster - English
- Fraud Poster - Spanish
- Fraud Poster - Chinese
- MPN Employee Guide (Covered Employee's Notification of Rights) - English - Required
- MPN Employee Guide (Covered Employee's Notification of Rights) - Spanish - Required
- Initial Medical Referral Form
- Employee Declination of Medical Treatment (EN/SP)
- What You Need To Do Right Now - Policyholders Checklist
- What To Do When an Injury Occurs - Policyholders Checklist
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- California Consumer Privacy Act (CCPA) Notice - English
- California SB 1159
- California, Go-Forward COVID-19 Employer Reporting Form
- Predesignation of Personal Physician
- Notice of Personal Chiropractor or Personal Acupuncturist
Return To Work
Documents Provided by PacificComp
- C-105 Form Required
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Documents Provided by PacificComp
- Bona Fide Job Offer
- Travel Reimbursement
- Portal User Guides
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Documents Provided by PacificComp
- DWC074 – Description of Injured Employee’s Employment
- DWC073 – Texas Workers’ Compensation Work Status Report
- DWC048 – Request to get reimbursed for travel costs
- Bona Fide Job Offer
- Texas Bona Fide Job Offer – Temporary Alternative Duty (BFJO) document added. -Per Rule 129.6, for the Bona Fide Job Offer to be valid a DWC073 (filled out by doctor) must be attached to the offer. (Blank DWC073 included for reference)
- Portal User Guides
- Pharmacy First Fill
- Pharmacy First Fill - Spanish
- Change of Address
- Witness Statement - English
- Witness Statement - Spanish
- Accident Report - English
- Accident Report - Spanish
- Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Arizona | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
Alabama | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
Alaska | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
Arkansas | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
California | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
Injured Workers Guide - English
California Division of Workers' Compensation (DWC) Fact Sheets
DWC Fact Sheets are documents that can be used by both the injured workers and the Policyholders to provide an overview of the laws that govern the claims administration process in the State of California. These forms are also available on the DWC website at www.dir.ca.gov
Employee Fact Sheets
Fact Sheet A: Utilization Review Fact Sheet English | Spanish
Fact Sheet B: Glossary of Workers' Comp Terms English | Spanish
Fact Sheet C: Temporary Disability Fact Sheet English | Spanish
Fact Sheet D: Permanent Disability Fact Sheet English | Spanish
Fact Sheet E: Qualified Medical Evaluation/Agreed Medical Evaluation Fact Sheet – English | Spanish
Medical Records Release of Injured Worker
When injured workers sign this form, they give CopperPoint permission to obtain their medical records so that CopperPoint can evaluate their claim.
Mileage Reimbursement Request for Injured Worker Use
Injured workers should use this form to log their mileage for travel related to their medical treatment so that CopperPoint can reimburse them.
Colorado | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
Connecticut | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
Delaware | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
Florida | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
Georgia | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
Hawaii | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
Idaho | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
Illinois | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
Indiana | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Iowa | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
Kansas | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
Kentucky | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
Louisiana | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
Maine | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
Massachusetts | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
Maryland | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
Michigan | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
Minnesota | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
Mississippi | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Missouri | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
Montana | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Nebraska | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
Nevada | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
New Hampshire | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
New Jersey | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
New Mexico | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's resources provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
New York | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
North Carolina | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
North Dakota | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Ohio | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
Oklahoma | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
Oregon | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
Pennslyvania | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
Rhode Island | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
South Carolina | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
South Dakota | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
Tennessee | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
Texas | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
Utah | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's resources provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
Vermont | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
Virginia | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
Washington | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
West Virginia | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Wisconsin | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
Wyoming | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
Washington, D.C. | Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
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