We would like to say THANK YOU for your decision to join the other employers, who are policyholders 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by reviewing the introductory section that expresses gratitude for joining as a policyholder. This sets a positive tone for your engagement.
  3. Fill out the 'General Information' section, ensuring all details about your company and contact information are accurate.
  4. Complete the 'Claims Information' section by following the instructions provided for each form listed, such as the Employer Report of Injury/Illness Form and Authorization for Release of Protected Health Information.
  5. Ensure that any required signatures are obtained from both the injured worker and employer representatives where applicable.
  6. Review all completed sections for accuracy before submitting through our platform, either via fax or email as specified in the instructions.

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