Claims Forms

We are pleased to provide you with the convenient option of downloading important claims forms. Please select the state in which you will be filing your claim:

 

Instructions for Reporting Workers’ Compensation Claims:

You may have noticed our injury reporting system looks different!

 
We have upgraded our web site so that you may report claims using any browser (Google Chrome, Firefox or Internet Explorer version 10 or newer)! Please bookmark the new links to our forms. The old links will not work any longer.

 
Please read the entire instruction before you click any links. Our preferred method of reporting is by completing an injury report via our website.

 

  • Have all employee demographic information and accident information handy.
  • Click on the link to the form you want to complete to report your claim. (Links are found below or directly on our website under “Report an Injury.”)
  • Complete the form filling in ALL FIELDS. Missing information could result in delays in the claim being set up.
  • You will no longer be able to PRINT before you submit.
  • Press the SUBMIT button. The injury report will be submitted electronically to us.
  • You will immediately receive an email confirmation and a PDF version of your injury report. Add our email address to your contacts. If you don’t receive an email please call us at 800.790.8877 option 1.

If you are reporting a Record Only or Medical Only Claim:
In Massachusetts, click this link
In New Hampshire, click this link

 

If you are reporting a Lost Time Claim:
In Massachusetts, click this link
In New Hampshire, click this link

 

Cove Risk reports claims electronically on your behalf with the required state agency in both Massachusetts and New Hampshire.

If you are unable to complete an injury report online, you can:

  • Complete an injury report manually and submit it via fax to 800.382.8891 Attn: New Claims Reporting or via email to froi@coverisk.com Do not email individual employees with injury reports.
  • Call us at 800-790-8877, option 1.

 

If you need other forms:
In Massachusetts, click here
In New Hampshire, click here

 

While you are here, have you registered for our new Safety Services? Please click here to learn more.

 

Our new Safety Awareness for Everyone (S.A.F.E.) Program has all of the resources you need to promote workplace health and safety, answer frequently asked questions, and support a successful risk safety program.