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Workers’ Compensation - Report A Claim
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Workers’ Compensation - Report A Claim

You can count on responsive service from our claims professionals. When reporting a claim for a workplace injury, it’s important to know that forms, reporting deadlines and workers’ compensation insurance statutes differ by state.

For help identifying your insurance company, please contact us at 800.231.1363.

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Steps after an incident occurs:

  • Report the Claim online, by email, phone or mail as soon as possible.
  • Pharmacy First Fill prescription cards are available for the employee to be able to fill the initial prescription for a work-related injury.
  • Report to OSHA. Employers are required to report certain injuries to OSHA in a timely manner.

Report a Claim

If your employee suffers an injury while at work, a state-specific claims form must be filed with CopperPoint. The employer should complete the claim form, not the employee.

Each state has its own regulations relative to a filing deadline. To provide efficient, responsive service, and to contain costs, the claim form should be filled out accurately and as soon as possible.

Claim Form: Employer's Report of Injury

  • View the Claims Kit to access the Employer's Report of Injury (Form 101) and other state-specific claims information.

After you complete the Employer’s Report of Injury form, located in the Forms section of the CopperPoint Arizona Claims Kit, 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.

Report Online

Reporting a claim via the Policyholder portal is the fastest, most efficient method.

Benefits of filing through the portal include immediately receiving:

  • Your claim number
  • Assigned adjuster contact information

Submit your claim online through our Policyholder Portal.

If you have not registered, you can reference our Policyholder Portal User Guide which will explain the registration process.

Report by Email

Report by Phone

Report by Mail

  • Mail your completed Employer's Report of Industrial Industry Form 101 to:
    CopperPoint Insurance Companies, 3030 N. 3rd Street, Phoenix, AZ 85012

When we receive the claims form, we will review the information, investigate and make a decision regarding the claim.

Pharmacy First Fill

The employee's first prescriptions are written by authorized workers’ compensation physicians for medications related to a workplace injury.

  • A pharmacy first fill card is available to expedite care and ensure there are no out-of-pocket expenses.

OSHA Reporting Requirements

Employers may be required to report in a timely manner any injuries, such as in-patient hospitalizations, amputations, loss of an eye, fatalities or permanent disfigurement to OSHA.

  • Please refer to OSHA for your specific jurisdiction requirements.
  • It also is important to notify CopperPoint at 800.231.1363 so the claim process can be initiated.

Helpful Resources

 

Claims Management

CopperPoint is recognized for quality customer care and stellar claims management. We stress open communications among all parties involved in an injury claim: the injured worker, the medical provider and CopperPoint’s claim representative.