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MCIM
  • Home
  • About MCIM
    • Products & Services
    • News
    • Careers
  • Claims
    • Report an Injury
    • Return to Work Program
    • The Value of Early Reporting
    • Florida Claims Forms
    • Georgia Claims Forms
    • Illinois Claims Forms
    • Indiana Claims Forms
    • Michigan Claims Forms
    • Wisconsin Claims Forms
  • Loss Prevention
    • Safety Inspections
    • Safety Resources
    • Safety Training Videos
    • Safety Training Programs
  • Bill Pay
  • Agencies
  • Contact Us
  • My MCIM
    • Newsletters

Report an Injury

MCIM’s Claims Department provides several easy and convenient methods to report workers’ compensation injuries, as well as responsive follow-up and monitoring. Once we receive a claim, either by phone, fax or online, be assured it will be promptly reviewed by our claims staff. With workers’ comp, quick response is critical for effective and efficient management.  Our examiners stay involved in each case, monitoring medical treatment in addition to keeping the policyholder and injured worker fully informed.

To help expedite the handling of a claim, the following options are available by clicking on the appropriate form below for your State. 
(NOTE: Adobe Acrobat Approval, Standard, or Professional version 5 or newer is required for submitting these forms by email.)
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  • Florida - First Report of Injury
  • Georgia - First Report of Injury
  • Illinois - First Report of Injury
  • Indiana - First Report of Injury
  • Michigan - First Report of Injury​

You may call or e-mail the completed injury report to:
Phone: 629-207-5941
[email protected]
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  • Home
  • About MCIM
    • Products & Services
    • News
    • Careers
  • Claims
    • Report an Injury
    • Return to Work Program
    • The Value of Early Reporting
    • Florida Claims Forms
    • Georgia Claims Forms
    • Illinois Claims Forms
    • Indiana Claims Forms
    • Michigan Claims Forms
    • Wisconsin Claims Forms
  • Loss Prevention
    • Safety Inspections
    • Safety Resources
    • Safety Training Videos
    • Safety Training Programs
  • Bill Pay
  • Agencies
  • Contact Us
  • My MCIM
    • Newsletters