Submit a Workers’ Compensation Claim

Use this form to report a workers' compensation claim for a workplace injury that occurred while working through Wrapbook.

Please complete as many fields as possible. Providing accurate and complete information helps us open the claim promptly and connect the injured worker with the care they need. Missing or incomplete information may delay claim processing.

Before submitting, please download the Workers' Comp Claims Kit and complete the forms that apply to the injury. Once they are filled out and signed, upload the completed documents in the Attachments section at the bottom of this form.