Claim Forms

Need to fill out a form?  Please click on the form below that you need to submit.  Fill it out on this website, and all your information will be sent to us.

Claim Forms

Employer's Report of Incident

Employer’s Report of Incident

(Employer Must Complete)

Employee's Report of Incident

Employee’s Report of Incident

(Employee must complete, but Employer may transcribe)


Master Policy Numbers

Business Insurers of Georgia SUNZ – WC014-00001-020

InSource United Wisconsin Insurance Company (UWIC) – WC526-00001-020-SZ

If you do business in one or more Multiple Coordinated Policy (MCP) states, a unique policy number for each MCP state will be assigned to you.


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