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

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CareComp First Report of Injury

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AAF First Report of Injury

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MWCF First Report of Injury

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AGC First Report of Injury