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First Report of Injury

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Enter Injury Information

This First Report of Injury is valid only for injured employees of policyholders covered by SFM Mutual Insurance Company and TPA clients of SFM Risk Solutions, Inc.

   
Important Notice

The filing of this First Report of Injury is not an admission of liability. If you have concerns about the validity of a claim, please explain in the "Confidential comments" section of this form (found on page 6).

"Confidential comments" are not included in the copy of the First Report of Injury sent to the employee.

Report all claimed injuries within five days. Injuries reported after 10 days may result in state penalties.

Any catastrophic injury or death must be reported within 24 hours; call
(952) 838-2020 or
(800) WC-CLAIM.

or questions about reporting, call
(952) 838-2020 or
(800) WC-CLAIM