Claim Forms

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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)


Policy Numbers

Business Insurers of Georgia Sunz – WC014-00001-019

Business Insurers of Georgia United Wisconsin Insurance Company (UWIC) – WC517-00001-019-SZ

InSource United Wisconsin Insurance Company (UWIC) – WC526-00001-019-SZ


Need a Printable Form?

Download the forms on this page and fill them out using your PDF reader.

Business Insurers of Georgia Sunz Forms

Sunz Authorization for Medical Treatment & Pharmacy First Fill

Business Insurers of Georgia United Wisconsin Insurance Company (UWIC)

UWIC Authorization for Medical Treatment & Pharmacy First Fill

InSource United Wisconsin Insurance Company (UWIC)

InSource Authorization for Medical Treatment & Pharmacy First Fill


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