HOW TO REPORT AN INJURY


Security National Insurance - California (Click Here)

State : California New York
California


Within 24 hours of knowledge of an injury, you will need to provide the injured worker with the DWC-1 Form, Employee’s Claim for Workers’ Compensation Benefits. Have the injured worker complete the top portion of the form and return it to the appropriate Supervisor or Manager. The employer will then complete the bottom portion of the document and give the injured worker a copy.

Next, you will need to complete the 5020 Form, Employer's Report of Occupational Illness or Injury. This form and the DWC-1 are provided in the Employer's Claim Kit package sent at policy inception and when your policy renews. Both forms can also be downloaded by clicking on the links on this page.

Once both of these documents are filled out, they need to be faxed to American All-Risk Loss Administrators at (800) 500-3486 or (559) 277-4961. Documents can be faxed at any time, 7 days a week. Or, claims can be reported to one of our operators, Monday through Friday, between the hours of 8:00 a.m. and 5:00 p.m.

After you fax these documents to AARLA, they are received by the "Fast Track" Department which handles the intake of new claims. You will receive a follow-up telephone call from the Fast Track Department to obtain and verify information that is needed in the initial investigation, and to advise you of AARLA's receipt of your claim. You may also wish to contact AARLA to ensure follow-up of the claim, and we can be reached at (800) 500-3744, or (559) 277-4960.

Please be sure to keep a copy of both the DWC-1 and 5020 documents for your records. California law requires that employers report within five days of knowledge a claim for an occupational injury or illness that results in lost time from work beyond the date of the incident OR requires medical treatment beyond first aid. Failure to report claims timely can jeopardize AARLA's ability to promptly investigate an injury, and can lead to unnecessary and excessive medical and disability costs, state penalties and fines, and a higher likelihood of litigation. Your cooperation in prompt reporting is a key factor in managing your workers' compensation insurance expenses.




New York


Within 10 days of an injury, you will need to complete the C-2 Employers Report of Work Related Injury/Illness form. This form is provided in the Employer's Claim Kit package sent at policy inception and when your policy renews. The form can also be downloaded by clicking on the links on this page.

Once the document is filled out, they need to be faxed to American All-Risk Loss Administrators at (888)-773-2239 or (631) 769-0373. Documents can be faxed at any time, 7 days a week. Or, claims can be reported to one of our operators, Monday through Friday, between the hours of 8:00 a.m. and 5:00 p.m.

After you fax these documents to AARLA, they are received by the "Fast Track" Department which handles the intake of new claims. You will receive a follow-up telephone call from the Fast Track Department to obtain and verify information that is needed in the initial investigation, and to advise you of AARLA's receipt of your claim. You may also wish to contact AARLA to ensure follow-up of the claim, and we can be reached at (888)-773-2238 , or (631)-319-6210. Please be sure to keep a copy of the C-2 for your records.

New York law requires that employers report within 10 days of knowledge a claim for an occupational injury or illness that results in lost time from work beyond the date of the incident OR requires medical treatment beyond first aid. Failure to report claims timely can jeopardize AARLA's ability to promptly investigate an injury, and can lead to unnecessary and excessive medical and disability costs, state penalties and fines, and a higher likelihood of litigation. Your cooperation in prompt reporting is a key factor in managing your workers' compensation insurance expenses.


New York Forms :
C-2 Employers Report of Work Related Injury/Illness form
C-11 Employers Report of Injured Employees Change
C-240 Employers Statement of Wage Earnings

DISCLAIMER

Any person who makes or causes to be made any false or fraudulent material statement or material representation for the purpose of obtaining or denying workers’ compensation benefits or payments is guilty of a felony.

 
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PO BOX 9783
Fresno, CA 93794
Phone : 559-277-4960
Fax : 559-277-4961