Report A Claim
Report a Claim
Please select the appropriate tab below for your state to Report a Claim.
Great Lakes Region
Servicing the states of Michigan, Ohio, Indiana, and Illinois
Report Online
Report By Email
Report By Fax
Email or fax your completed forms:
Michigan Employer’s First Report of Injury Form
Ohio Employer’s First Report of Injury Form
Central Region
Servicing the states of Minnesota, North Dakota, South Dakota, Nebraska, Iowa, and Wisconsin
Report By Email
Report By Fax
Report By Phone
Email or fax your completed forms:
Minnesota Employer’s First Report of Injury Form
South Region
Servicing the state of Alabama
Report By Email
Report By Fax
Report By Mail
Mackinaw Administrators, LLC
P.O. Box 219152
Kansas City, MO 64121
Email, fax or mail your completed forms:
Alabama Employer’s First Report of Injury Form
East Region
