MRM Clients can report work injury claims 24 hours a day, 7 days a week by downloading the First Report of Injury form, filling it out, saving a copy of the completed form and submitting it using the button below, or fax to (205) 703-7022. All claims should be reported immediately upon notification to the employer. The party submitting a First Report of Injury form should identify succinct and complete contact information in their e-mail or Fax cover sheet.

 

You will need the following information to complete the form:

• Injured worker’s: Name; Address; Telephone Number; Social Security Number; Date of Hire and Date of Birth

• Date of Injury and Description of Injury

• Name and Address of Medical Provider

• Wage Information

• Ten-Digit Alabama Employer Unemployment Compensation Number