Submit A Workers  Comp Claim

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

CareComp First Report of Injury

AAF First Report of Injury

MWCF First Report of Injury

AGC First Report of Injury

Millennium Risk Managers

P. O. Box 382408

Birmingham, AL 35238

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