Claims Forms

Here are some claims forms that you may have to fill out throughout your claim. Once these forms are filled, send them back to your examiner to keep the claim process moving forward.

How to Report a Claim

If an injury is an emergency please call 911 or have them seen in the ER, once the injury has stabilized call Company Nurse at 1-888-770-0928. If the injury is not an emergency, please call Company Nurse as soon as possible.

Promptly reporting a claim is a critical first step to ensuring injured workers receive the care they need. IMWCA partners with Company Nurse to provide telephonic reporting and nurse triage to injured workers.

Prescription Program

IMWCA partnered with Splashlight RX to provide pharmacy benefits to injured workers. The program allows injured workers to quickly and easily obtain needed medication without them incurring out-of-pocket costs.

Splashlight Rx issues pharmacy cards to injured workers who need prescriptions for their work-related injuries. These pharmacy cards allow the injured employee to fill their prescriptions without worrying about who is supposed to be billed for the medication.