Claims Information
When an injury occurs, employers have seven (7) days to report the incident (24 hours when the injury results in death).
Have the following information ready:
- Full name, address, telephone number of injured employee
- Occupation, date of birth, sex of injured employee
- The injured employee's Social Security number
- Date and time of accident
- Employee's description of accident
- Injury/illness that occurred, part of body injured
- Company name, phone, address
- Employer's location if address is different from above
- Place/address accident occurred
- Federal Employer ID# and Policy Number
- Employee date of hire
- Did the employee return to work?
- Do you (the employer) agree with the accident?
- Name of physician or hospital where employee was sent by you for treatment
Summit Holdings
Claims Center
P.O. Box 2928
Lakeland, FL 33806-2928
(863) 665-6629
1-800-282-7644
Claims Reporting Hotline (24 hours a day, 7 days a week): 1-800-762-7811
Heritage Summit HealthCare
P.O. Box 3623
Lakeland, FL 33802-3623
1-800-282-7644
Associated Industries Insurance Services
The toll-free 1st Report of Injury line is manned by specialists that promptly and effectively expedite the claims management process.
First Report of Injury 888-225-2442
Amerisafe
Claim Reporting
Our toll free accident reporting system, 1-800-699-6240, is essential in providing us immediate notification of accidents. We will ask you questions and prepare the claim report for you. The sooner we know of injuries the quicker we can begin to work with the injured worker and his family to assure that quality medical treatment is provided. Due to the diversity of the American workforce we have the ability to receive injury reports in many languages.1-800-699-6240
Field Case Managers
Our “face to face” approach requires that our Field Case Managers live in proximity to our clients and injured workers. They have many years of experience and are supported by Nurse Case Managers and other resources that their time may be spend on the needs of injured workers. Each has an average case load of approximately sixty injured workers. We believe this is a very low number compared to other workers' compensation insurers, and affords them ample time to spend with each injured worker to produce a quality relationship and best outcomes.
Aequicap Insurance Company
All workers' compensation claims require a statement from the employee, the medical provider and the employer. To report a workers' compensation claim, call 800/275-2300.
The loss hotline is answered 24-hours a day, seven days a week.
Florida Hospitality Mutual (FHM)
Fax or Mail
You must use the current, state First Report of Injury form [LES Form DWC-1 (11/94)). This form can be downloaded from the FHM web site, filled in, printed and sent to FHM.
Fax: 1-407-352-5788
Mail to:
FHM Insurance Company, Inc.
P.O. Box 616648
Orlando, FL 32861-6648
Telephone
Call FHM at 888-346-3461, Extension 353, no later than the next business day to report the injury.
First Commercial Underwriter LLC
Phone 800-291-7776 or 786-621-3130
Bankers Insurance Group
Claims Office: 800-765-9700.
Unisource Administrators
Loss Reporting Unisource Administrators looks forward to working with you. Our complete offering of loss prevention services, claims management, managed care services and prompt return to work initiatives will ensure employees understand their benefits in a timely manner.
Report claims immediately to 888-461-1212 or fax our claim department at 941-342-6939. Claims available 24/7.
