State of Alabama—http://www.al.gov/
Department of Industrial Relations—http://dir.alabama.gov/
Workers' Compensation Division—http://dir.alabama.gov/wc/
Industrial Relations Building
649 Monroe Street
Montgomery, Alabama 36131
(800) 528-5166, (334) 242-2868; Fax: (334) 353-8262 (Administrative/TPAs/Assessments/Self-Insurance), (334) 353-8228 (Examiners/Ombudsman), (334) 353-0840 (Claims), (334) 353-8490 (Compliance/Drug Free/Medical/Education); Fraud: (800) 923-2533; Ombudsman: (800) 528-5166, (334) 242-2868 (in Montgomery area)

Alaska

State of Alaska—http://www.state.ak.us/
Department of Labor and Workforce Development—http://www.labor.state.ak.us/home.htm
Workers' Compensation Division—http://www.labor.state.ak.us/wc/wc.htm
Post Office Box 25512
Juneau, Alaska 99802-5512
(907) 465-2790; Fax: (907) 465-2797

Workers' Compensation Board—http://www.gov.state.ak.us/boards/factsheet/fact110.html
Department of Labor
Post Office Box 25512
M/S 0700
Juneau, Alaska 99802-5512
(907) 465-2790, Fax: (907) 465-2797

Arizona

State of Arizona—http://www.state.az.us/
Industrial Commission of Arizona—http://www.ica.state.az.us/
800 West Washington
Phoenix, Arizona 85007
or
Post Office Box 19070
Phoenix, Arizona 85005-9070
(602) 542-4411, Fax: (602) 542-7889; Ombudsman: (602) 542-4538, Fax: (602) 542-4350
Click here to download free fillable PDF (Portable Document Format) versions of Arizona workers' compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

Industrial Commission Review Board

http://www.statefund.com/
3031 North Second Street
Phoenix, Arizona 85012
(602) 631-2000; Fax: (602) 631-2213

Arkansas

State of Arkansas—http://www.state.ar.us/
Workers' Compensation Commission—http://www.awcc.state.ar.us/
Street Address:
324 Spring Street
Little Rock, Arkansas 72203
Mailing Address:
Post Office Box 950
Little Rock, Arkansas 72203-0950
(800) 622-4472, (501) 682-3930; Fax: (501) 682-2777; Legal Advisor Direct: (800) 250-2511; TDD: (800) 285-1131
Arkansas Relay System TDD: (800) 285-1131

California

State of California—http://www.ca.gov/s/
Department of Industrial Relations—http://www.dir.ca.gov/
Commission on Health and Safety and Workers' Compensation (CHSWC)—http://www.dir.ca.gov/CHSWC/chswc.html
455 Golden Gate Avenue, 10th Floor
San Francisco, California 94102
(415) 557-1304, Fax: (415) 703-4234, E-mail: chswc@hq.dir.ca.gov

Division of Workers' Compensation (DWC)—http://www.dir.ca.gov/DWC/dwc_home_page.htm
Street Address:
455 Golden Gate Avenue, 9th Floor
San Francisco, California 94102-3660
Mailing Address:
Post Office Box 420603
San Francisco, California 94142
E-mail: dwc@dir.ca.gov
(415) 703-4600 ; Fax: (415) 703-3971
Click here to download free fillable PDF (Portable Document Format) versions of California workers' compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

Industrial Medical Council (IMC)—http://www.dir.ca.gov/IMC/imchp.html
Post Office Box 8888
San Francisco, California 994128-8888
(800) 794-6900 (in California), (650) 737-2000

Workers' Compensation Appeals Board (WCAB)—http://www.dir.ca.gov/WCAB/wcab.htm
Street Address:
455 Golden Gate Avenue, Suite 9328
San Francisco, California 94102-3660
Mailing Address:
Post Office Box 429459
San Francisco, California 94142-9459
(415) 703-4580

Self-Insurance Plans (SIP)—http://www.dir.ca.gov/SIP/sip.html
2265 Watt Avenue, Suite 1
Sacramento, California 95825
(916) 483-3392; Fax: (916) 483-1535
E-mail: SIP@dir.ca.gov

State Compensation Insurance Fund (SCIF)—http://www.scif.com/
1275 Market Street
San Francisco, California 94103
(415) 565-1234, Claims Reporting Service (toll free): (888) 222-3211

Colorado

State of Colorado—http://www.state.co.us/
Department of Labor & Employment—http://www.coworkforce.com/
Division of Workers' Compensation—http://www.coworkforce.com/DWC/
1515 Arapahoe Street
Tower 2, Suite 500
Denver, Colorado 80202-2117
(888) 390-7936 (English), (800) 685-0891 (Spanish), (303) 318-8700, Fax: (303) 318-8710, E-mail: workers.comp@state.co.us
Click here to download free fillable PDF (Portable Document Format) versions of Colorado workers' compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

Industrial Claims Appeals Office
Workers' Compensation: (303) 318-8131
Unemployment Insurance: (303) 318-8133
1515 Arapahoe Street
Tower 2, Suite 350
Denver, Colorado 80202
(303) 318-8133

Connecticut

State of Connecticut—http://www.state.ct.us/index.asp
Workers' Compensation Commission—http://wcc.state.ct.us/
Capitol Place
21 Oak Street, Fourth Floor
Hartford, Connecticut 06106
(860) 493-1500, Fax: (860) 247-1361
Click here to download free fillable PDF (Portable Document Format) versions of Connecticut workers' compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

Compensation Review Board (CRB)—http://wcc.state.ct.us/index2.htm
Capitol Place
21 Oak Street, Fourth Floor
Hartford, Connecticut 06106
(203) 493-1500, Fax: (203) 247-1361

Delaware

State of Delaware—http://www.state.de.us/
Department of Labor—http://www.delawareworks.com/
4425 North Market Street
Wilmington, Delaware 19802
Division of Industrial Affairs—http://www.delawareworks.com/divisions/industaffairs/diaindex.html
4425 North Market Street
Wilmington, Delaware 19802
Office of Workers' Compensation—http://www.delawareworks.com/divisions/industaffairs/workers.comp.htm
State Office Building, Sixth Floor
820 North French Street
Wilmington, Delaware 19801

District of Columbia

District of Columbia—http://www.dc.gov/
Department of Employment Services—http://www.does.dc.gov/does/site/default.asp
Government of the District of Columbia
64 New York Avenue, N.E.
Washington, District of Columbia 20002
(202) 724-7000, Fax: (202) 724-5683, TDD/TYY: (202) 673-6994
E-mail: does@dc.gov

Labor Standards Bureau
64 New York Avenue, N.E., Room 3129
Washington, District of Columbia 20002
(202) 671-1555, Fax: (202) 673-6412

Office of Workers' Compensation—http://www.does.dc.gov/does/cwp/view.asp?a=1232&Q=537428
Mailing Address:
Post Office Box 56098
Washington, District of Columbia 20002
Street Address:
64 New York Avenue, N.E., Room 2909
Washington, District of Columbia 20002
(202) 671-1000, Fax: (202) 671-1929

Office of Hearings and Adjudication—http://www.does.dc.gov/does/cwp/view.asp?a=1232&Q=537904
64 New York Avenue, N.E., Room 2011
Washington, District of Columbia 20002
(202) 671-2233, Fax: (202) 673-6938

Florida

State of Florida—http://www.myflorida.com/
Florida Department of Financial Services—http://www.fldfs.com/
Division of Workers' Compensation—http://www.fldfs.com/WC/
301 Forrest Building
2728 Centerview Drive
Tallahassee, Florida 32399-0680
(850) 921-6966; Fax: (850) 922-6779; Fraud: (800) 742-2214 (in Florida) (Department of Insurance, Bureau of Workers' Compensation Fraud: (850) 413-3116); Safety: (800) 367-4378 (in Florida), (850) 488-3044
E-mail: WorkCompCusServ@dfs.state.fl.us
Click here to download free fillable PDF (Portable Document Format) versions of Florida workers' compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

http://www.doi.state.fl.us/wc/pdf/2kAR_OversightBoard.PDF
100 Marathon Building
2574 Seagate Drive
Tallahassee, Florida 32399-2152
(850) 487-2613, SunCom: 277-2613; Fax: (850) 487-3232

Florida Division of Administrative Hearings—http://www.doah.state.fl.us/internet/
Office of Judges of Compensation Claims—http://www.jcc.state.fl.us/jcc/default.cfm
Petition for Benefits:
Post Office Box 8000
Tallahassee, Florida 32314-8000
Filing:
Post Office Box 6350
Tallahassee, Florida 32314-6350
Request for Assignment of Case Number:
Post Office Box 6410
Tallahassee, Florida 32314-6410
(850) 487-1911, SUNCOM 277-1911

Georgia

State of Georgia—http://www.state.ga.us/
Georgia State Board of Workers' Compensation—http://www.ganet.org/sbwc/
270 Peachtree Street, NW
Atlanta, Georgia 30303-1299
(800) 533-0682, (404) 656-3875, Fax: (404) 656-7768, Enforcement Division: (404) 657-1391, Safety Library: (404) 656-9057
Click here to download free fillable PDF (Portable Document Format) versions of Georgia workers' compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

Georgia Subsequent Injury Trust Fund—http://www.ganet.org/sitf/
Suite 500, North Tower
1720 Peachtree Street, NW
Atlanta, Georgia 30309-2420
(404) 206-6360, Fax: (404) 206-6363, TDD: (404) 206-5053

Hawaii

http://www.hawaii.gov/ (DLIR)—http://dlir.state.hi.us/

Disability Compensation Division
830 Punchbowl Street, Room 209
Honolulu, Hawaii 96813
(808) 586-9174, Fax: (808) 586-9219
E-mail: pstanley@pixi.com

Labor & Industrial Relations Appeals Board
888 Mililani Street, Room 400
Honolulu, Hawaii 96813
(808) 586-8600, Fax: 586-8613
E-mail: pstanley@pixi.com

Idaho

State of Idaho—http://www2.state.id.us/
Industrial Commission—http://www.state.id.us/iic/index.htm
317 Main Street
Post Office Box 83720
Boise, Idaho 83720-0041
(800) 950-2110, (208) 334-6000; Fax: (208) 334-2321; TDD: (800) 950-2110

State Insurance Fund—http://www.state.id.us/isif/index.htm
1215 West State Street
Post Office Box 83720
Boise, Idaho 83720-0044
(800) 334-2370, (208) 334-2370 (in the Boise area); Fax: (208) 334-2262 (Policyholder Services, Administration, Management Services, Legal), (208) 334-3253 (Claims), (208) 334-3254 (Underwriting); Fraud: (800) 448-ISIF (4743)

Illinois

State of Illinois—http://www.il.gov/
http://www.iwcc.il.gov/
100 West Randolph Street, Suite 8-200
Chicago, Illinois 60601
(866) 352-3033 (toll free statewide), (312) 814-6611, Fax: (312) 814-6523, TDD: (312) 814-2959
E-mail: iicoperations@mail.state.il.us
Click here to download free fillable PDF (Portable Document Format) versions of Illinois workers' compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

Office of Self-Insurance Administration
701 South Second Street
Springfield, Illinois 62704
(217) 785-7084, Fax: (217) 785-6557

Indiana

State of Indiana—http://www.in.gov/
Workers' Compensation Board of Indiana—http://www.in.gov/workcomp/
Government Center South
402 West Washington Street, Room W-196
Indianapolis, Indiana 46204
(317) 232-3808; Claims/Statistics: (317) 233-4930; Fax: (317) 233-5493; Insurance: (317) 233-3910; Ombudsman: (800) 824-COMP (2667), (317) 232-5922

Iowa

State of Iowa—http://www.state.ia.us/
Iowa Workforce Development—http://www.iowaworkforce.org/
1000 East Grand Avenue
Des Moines, Iowa 50319-0209
(800) JOB-IOWA, (515) 281-5387
Iowa Division of Workers' Compensation—http://www.iowaworkforce.org/wc/
1000 East Grand Avenue
Des Moines, Iowa 50319-0209
(800) JOB-IOWA (562-4692), (515) 281-5387; Fax: (515) 281-6501, TTD: (515) 281-4748
E-mail: IWD.DWC@iwd.state.ia.us

Kansas

State of Kansas—http://www.state.ks.us/
Department of Human Resources—http://www.hr.state.ks.us/
Kansas Workers' Compensation—http://www.hr.state.ks.us/wc/html/wc.htm
800 SW Jackson, Suite 600
Topeka, Kansas 66612-1227
(800) 332-0353, (785) 296-3441; Fax: (785) 296-0839; Fraud: (800) 332-0353, (785) 296-6392; Industrial Safety & Health: (800) 332-0353, (785) 296-4386; Ombudsman: (800) 332-0353, (785) 296-2996

Kentucky

Commonwealth of Kentucky—http://kentucky.gov/
Kentucky Department of Labor—http://labor.ky.gov/
1047 U.S. 127S, Suite 4
Frankfort, Kentucky 40601
(502) 564-3070
Office of Workers' Claims—http://labor.ky.gov/dwc/
657 Chamberlin Avenue
Frankfort, Kentucky 40601
(502) 564-5550 (Administrative Services, Open Records); Fax: (502) 564-8250 (Administrative Services), (502) 564-9533 (Ombudsman), (502) 564-5732 (Open Records), (502) 564-0916 (Security and Compliance); Ombudsman: (800) 554-8601 (Frankfort), (800) 554-8603 (Paducah), (800) 554-8602 (Pikeville); Security and Compliance: (502) 564-5550
E-mail: kywc.ombudsman@mail.state.ky.us

♥

♥

Click here to download free fillable PDF (Portable Document Format) versions of Kentucky workers' compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

Workers' Compensation Board

Division of Workers' Compensation Funds
1047 U.S. 127 South, Suite 4
Frankfort, Kentucky 40601
(502) 564-3070, ext. 391

Workers' Compensation Funding Commission
#42 Millcreek Park
Post Office Box 1220
Frankfort, Kentucky 40602-1220
(502) 573-3505, Fax: (502) 573-4923

Kentucky Workers' Compensation Law (via CompEd, Inc.)—http://www.comped.net/

Louisiana

State of Louisiana—http://www.louisiana.gov/wps/portal/
Department of Labor—http://www.laworks.net/
Mailing Address:
Post Office Box 94094
Baton Rouge, Louisiana 70804-9094
Street Address:
1001 North 23rd Street
Baton Rouge, Louisiana 70804-9094
(225) 342-3111, TDD: (800) 259-5154
Office of Workers' Compensation Administration—http://www.laworks.net/wrk_owca.asp
Mailing Address:
Post Office Box 94040
Baton Rouge, Louisiana 70804-9040
Street Address:
1001 North 23rd Street
Baton Rouge, Louisiana 70802-9094
(225) 342-7555, Fax: (225) 342-5665, Fraud: (800) 201-3362 or WCFraud@ldol.state.la.us, Safety: (800) 201-2497
E-mail: OWCA@ldol.state.la.us

Maine

State of Maine—http://www.maine.gov/
Workers' Compensation Board—http://www.maine.gov/wcb/
27 State House Station
Augusta, Maine 04333-0027
(207) 287-3751; Fax: (207) 287-7198
Click here to download free fillable PDF (Portable Document Format) versions of Maine workers' compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

Maryland

State of Maryland—http://www.state.md.us/
Maryland Workers' Compensation Commission—http://www.charm.net/~wcc/
10 East Baltimore Street
Baltimore, Maryland 21202
(800) 492-0479, (410) 864-5100; Fax: (410) 333-8122
Click here to download free fillable PDF (Portable Document Format) versions of Maryland workers' compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

Insured Workers' Insurance Fund—http://www.iwif.com/
8722 Loch Raven Boulevard
Towson, Maryland 21286-2235
(800) 492-0197, (410) 494-2200 Fax: (410) 494-2001

Massachusetts

Commonwealth of Massachusetts—http://www.mass.gov/
Department of Industrial Accidents—http://www.mass.gov/dia/
600 Washington Street, Seventh Floor
Boston, Massachusetts 02111
(800) 323-3249, (617) 727-4900; Fax: (617) 727-6477; TTY: (800) 224-6196
Click here to download free fillable PDF (Portable Document Format) versions of Massachusetts workers' compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

Massachusetts Workers' Compensation Advisory Council—http://www.mass.gov/wcac/
600 Washington Street, Seventh Floor
Boston, Massachusetts 02111
(617) 727-4900, ext. 378; Fax: (617) 727-7122

Workers’ Compensation Rating and Inspection Bureau of Massachusetts—https://www.wcribma.org/mass/
101 Arch Street
Boston, Massachusetts 02110
(617) 439-9030, Fax: (617) 439-6055

Michigan

http://www.migov.state.mi.us/MichiganGovernor.htm
Department of Labor & Economic Growth—http://www.michigan.gov/cis
Street Address:
611 W. Ottawa
Lansing, Michigan 48909
Mailing Address:
Post Office Box 30004
Lansing, Michigan 48909
(517) 373-1820, Fax: (517) 373-2129
Workers' Compensation Agency—http://www.michigan.gov/wca
Street Address:
State Secondary Complex
General Office Building
7150 Harris Drive
First Floor, B-Wing
Lansing, Michigan 48913
Mailing Address:
Post Office Box 30016
Lansing, Michigan 48909
(888) 396-5041, (517) 322-1296, Fax: (517) 322-1808, TDD in Lansing: (517) 322-5987
Click here to download free fillable PDF (Portable Document Format) versions of Michigan workers' compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

Board of Magistrates—http://www.michigan.gov/wca/0,1607,7-191-26919---,00.html
Post Office Box 30016
Lansing, Michigan 48909
(517) 241-9380, Fax: (517) 241-9379, TDD in Lansing: (517) 322-5987

Workers' Compensation Appellate Commission—http://www.cis.state.mi.us/wkrcomp/wcac/home.htm
Victor Office Center, Third Floor
201 North Washington Square
Post Office Box 30468
Lansing, Michigan 48909-7968
(517) 335-5828, Fax: (517) 335-5829

Michigan Economic Development Corporation—http://medc.michigan.org/
300 North Washington Square
Lansing, Michigan 48913
(517) 373-9808
Michigan Business Guide to Workers' Compensation—http://medc.michigan.org/services/workerscomp/
Compensation Cost Control Service
Victor Office Center, Fourth Floor
201 North Washington Square
Lansing, Michigan 48909-7968
(517) 373-9809, Fax: (517) 241-3689

Minnesota

http://www.state.mn.us/
Department of Labor and Industry—http://www.doli.state.mn.us/
443 Lafayette Road North
St. Paul, Minnesota 55155-4307
(800) DIAL-DLI (342-5354), (651) 284-5005; TTY: (651) 297-4198

Workers' Compensation Division—http://www.doli.state.mn.us/workcomp.html
443 Lafayette Road North
St. Paul, Minnesota 55155
(800) DIAL-DLI (342-5354) in Greater Minnesota, (651) 284-5005 in the St. Paul area, (800) 365-4584 or (218) 733-7810 in the Duluth area; Fax: (651) 284-5727
E-mail: DLI.Workcomp@state.mn.us
Click here to download free fillable PDF (Portable Document Format) versions of Minnesota workers' compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

Workers' Compensation Court of Appeals—http://www.workerscomp.state.mn.us/
405 Minnesota Judicial Center
25 Dr. Martin Luther King Jr. Boulevard
St. Paul, Minnesota 55155
(651) 296-6526, Fax: (651) 297-2520, TTY/TDD: (800) 627-3529

Mississippi

State of Mississippi—http://www.state.ms.us/its/msportal.nsf?Open
Mississippi Workers' Compensation Commission—http://www.mwcc.state.ms.us/
Street Address:
1428 Lakeland Drive
Jackson, Mississippi 39216
Mailing Address:
Post Office Box 5300
Jackson, Mississippi 39296-5300
(601) 987-4200, Fraud: (601) 359-4250

Missouri

State of Missouri—http://www.state.mo.us/
Department of Labor and Industrial Relations—http://www.dolir.missouri.gov/index.htm
Street Address:
3315 West Truman Boulevard, Room 213
Jefferson City, Missouri 65102
Mailing Address:
Post Office Box 504
Jefferson City, Missouri 65102-0504
(573) 751-9691, Fax: (573) 751-4135

Division of Workers' Compensation—http://www.dolir.state.mo.us/wc/index.htm
Street Address:
3315 West Truman Boulevard, Room 131
Jefferson City, Missouri 65102
Mailing Address:
Post Office Box 58
Jefferson City, Missouri 65102-0058
(573) 751-4231, Fax: (573) 751-2012, Employee Hotline: (800) 775-2667, Employer Hotline: (888) 837-6069, Fraud and Noncompliance: (800)-592-6003, (573)-526-6630, Workers' Safety Program: (573) 526-3504
E-mail: Workerscomp@dolir.mo.gov
Click here to download free fillable PDF (Portable Document Format) versions of Missouri workers' compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

Labor and Industrial Relations Commission—http://www.dolir.state.mo.us/lirc/index.htm
3315 West Truman Boulevard
Jefferson City, Missouri 65102
or
Post Office Box 599
Jefferson City, Missouri 65102-0599
(573) 751-2461, Fax: (573) 751-7806

Montana

State of Montana—http://www.state.mt.us/
Montana State Fund—http://www.montanastatefund.com/
STREET ADDRESS:
    5 South Last Chance Gulch
    Helena, Montana 59601
MAILING ADDRESS:
    Post Office Box 4759
    Helena, Montana 59604-4759
(406) 444-6500, Claim Reporting/Customer Service: (800) 332-6102, Fraud Reporting: (888) 682-7463

Workers' Compensation Court—http://wcc.dli.state.mt.us/
1625 11th Avenue
Helena, Montana
or
Post Office Box 537
Helena, Montana 59624-0537
(406) 444-7794, Fax: (406) 444-7798
E-mail: pkessner@state.mt.us

Employment Relations Division—http://erd.dli.state.mt.us/
Department of Labor & Industry—http://dli.state.mt.us/
Post Office Box 8011
Helena, Montana 59624
(406) 444-6530, Fax: (406) 444-4140, Fraud: (800) 922-2873

Self Insurers' Guaranty Fund
Post Office Box 4133
Missoula, Montana 59806
(406) 549-8849

Nebraska

State of Nebraska—http://www.state.ne.us/
Workers' Compensation Court—http://www.nol.org/home/WC/
State House, 13th Floor
Post Office Box 98908
Lincoln, Nebraska 68509-8908
(800) 599-5155 (in Nebraska only), (402) 471-6468 (Lincoln and out of state), Fax: (402) 471-2700

Nevada

State of Nevada—http://www.nv.gov/

Department of Business & Industry—http://dbi.state.nv.us/
In Northern Nevada:
788 Fairview Avenue, Suite 100
Carson City, Nevada 89701-5491
(775) 687-4250, Fax: (775) 687-4266
E-Mail: biinfo@dbi.state.nv.us

In Southern Nevada:
555 E. Washington Avenue, Suite 4900
Las Vegas, Nevada 89101
(702) 486-2750, Fax: (702) 486-2758
E-Mail: biinfo@dbi.state.nv.us

Division of Industrial Relations—http://dirweb.state.nv.us/
400 West King Street, Suite 400
Carson City, Nevada 89703
(775) 684-7260, Fax: (775) 687-6305

http://dirweb.state.nv.us/iirs.htm
400 West King Street, Suite 400
Carson City, Nevada 89703
(775) 684-7270, Fax: (775) 687-6305

1301 North Green Valley Parkway, Suite 200
Henderson, Nevada 89014
(702) 486-9080, Fax: (702) 990-0364

Nevada Attorney for Injured Workers—http://naiw.nv.gov/

555 E. Washington Avenue, Suite 4800
Las Vegas, Nevada 89101
(702) 486-2830, Fax: (702) 486-2844
E-mail: NAIW@govmail.state.nv.us

1000 East William Street, Suite 213
Carson City, Nevada 89710
(775) 687-4076, Fax: (775) 687-4134
E-mail: NAIW@govmail.state.nv.us

Employers Insurance Company of Nevada—http://www.employersinsco.com/
9790 Gateway Drive, Suite 100
Reno, Nevada 89521

2550 Paseo Verde Parkway
Henderson, Nevada 89074-7117
(888) 682-6671; Claim Reporting: (888) 900-1455, Fax: (888) 527-3422; Underwriting/Insurance Services: (888) 682-6671
E-mail: info@eigwc.com

New Hampshire

State of New Hampshire—http://www.state.nh.us/
Department of Labor—http://www.state.nh.us/dol/index.html
95 Pleasant Street
Concord, New Hampshire 03301
(603) 271-3177
Workers' Compensation Division—http://www.state.nh.us/dol/wc/index.html
95 Pleasant Street
Concord, New Hampshire 03301
(603) 271-3174 (claims), (603) 271-2042 (coverage), (603) 271-6172 (self-insurance), (603) 271-3328 (vocational rehabilitation)
Click here to download free fillable PDF (Portable Document Format) versions of New Hampshire workers' compensation forms courtesy Interface

New Jersey

State of New Jersey—http://www.state.nj.us/
Department of Labor—http://www.state.nj.us/labor/
John Fitch Plaza
Post Office Box 110
Trenton, New Jersey 08625
(609) 292-2323, Fax: (609) 633-9271
Division of Workers' Compensation—http://www.nj.gov/labor/wc/wcindex.html
Post Office Box 381
Trenton, New Jersey 08625-0381
(609) 292-2515, Fax: (609) 984-2515
E-mail: dwc@dol.state.nj.us
Click here to download free fillable PDF (Portable Document Format) versions of New Jersey workers' compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

N.J. Compensation Rating and Inspection Bureau—http://www.njcrib.com/
60 Park Place
Newark, New Jersey 07102
(973) 622-6014, Fax: (973) 622-6110

♥

♥

New Mexico

State of New Mexico—http://www.state.nm.us/
Workers' Compensation Administration—http://www.state.nm.us/wca/
Post Office Box 27198
Albuquerque, New Mexico 87125-7198
E-mail: WCAHotline@state.nm.us
(800) 255-7965, (505) 841-6000, Fax: (505) 841-6009, Help Line/Hot Line: (866) WORKOMP (967-5667)

New York

State of New York—http://www.state.ny.us/
New York State Workers' Compensation Board—http://www.wcb.state.ny.us/
100 Broadway-Menands
Albany, New York 12241
(518) 474-6670, Fax: (518) 473-1415
Click here to download free fillable PDF (Portable Document Format) versions of New York workers' compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

New York State Insurance Fund—http://www.nysif.com/
199 Church Street
New York, New York 10007
(212) 312-9000, Fax: (212) 385-2073

North Carolina

State of North Carolina—http://www.sips.state.nc.us/
Department of Commerce—http://www.nccommerce.com/
Mailing Address:
4301 Mail Service Center
Raleigh, North Carolina 27699-4301
Street Address:
301 North Wilmington Street
Raleigh, NC 27020-0571
(919) 733-4151
E-mail: info@mail.commerce.state.nc.us

North Carolina Industrial Commission—http://www.comp.state.nc.us/
Mailing Address:
4319 Mail Service Center
Raleigh, North Carolina 27699-4319
Street Address:
Dobbs Building (sixth floor)
430 North Salisbury Street
Raleigh, North Carolina 27603-5937
(919) 807-2500, Fax: (919) 715-0282
    Fraud Investigations Section: (888) 891-4895 (in North Carolina)—http://www.comp.state.nc.us/ncic/pages/fraud.htm
    Ombudsman Section: (800) 688-8349—http://www.comp.state.nc.us/ncic/pages/ombudsmn.htm
    Safety Education Section: (919) 807-2603—http://www.comp.state.nc.us/ncic/pages/safety.htm
Click here to download free fillable PDF (Portable Document Format) versions of North Carolina workers' compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

North Dakota

State of North Dakota—http://discovernd.com/
Workforce Safety & Insurance—http://www.WorkforceSafety.com/
1600 East Century Avenue, Suite One
Bismarck, North Dakota 58506-5585
(800) 777-5033, (701) 328-3800; Fax: (701) 328-3820; Fraud: (800) 243-3331; Safety and Loss Prevention: (701) 328-3886; TDD: (701) 328-3786
E-mail: WorkforceSafety@wcb.state.nd.us
Workforce Safety & Insurance Board of Directors
Post Office Box 2174
Bismarck, North Dakota 58502-2174

Ohio

http://www.state.oh.us/
Ohio Bureau of Workers' Compensation—http://www.ohiobwc.com/
30 West Spring Street
Columbus, Ohio 43215-2256
E-mail: Feedback@bwc.state.oh.us
(800) OHIOBWC, (614) 644-6292, Fax: (614) 752-9021
Click here to download free fillable PDF (Portable Document Format) versions of Ohio workers' compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

Industrial Commission of Ohio—http://www.ohioic.com/index.jsp
30 West Spring Street
Columbus, Ohio 43215-2256
(800) 521-2691, (614) 466-6136, Fax: (614) 752-8304

Oklahoma

State of Oklahoma—http://www.state.ok.us/
Department of Labor—http://www.okdol.state.ok.us/
4001 North Lincoln Boulevard
Oklahoma City, Oklahoma 73105-5212
(888) 269-5353, (405) 528-1500 Fax: (405) 528-5751
Workers' Enforcement Compensation Division—http://www.okdol.state.ok.us/workcomp/index.htm

Oklahoma Workers' Compensation Court—http://www.owcc.state.ok.us/
Denver N. Davison Court Building
1915 North Stiles
Oklahoma City, Oklahoma 73105
(800) 522-8210 (statewide), (405) 522-8600, Fax: (405) 522-8687 (administration), (405) 522-8683 (2nd floor offices), (405) 522-8651 (records department)

CompSource Oklahoma—http://www.compsourceok.com/
(formerly the Oklahoma State Insurance Fund)
Mailing Address:
Post Office Box 53505
Oklahoma City, Oklahoma 73152-3505
Street Addresses:
(Administration, Claims, Financial Services, Special Investigations)
1901 North Walnut Avenue
Oklahoma City, Oklahoma 73105
(Policyholder Services, Information Systems)
410 North Walnut Avenue
Oklahoma City, Oklahoma 73104
(800) 872-7015 (Report an Injury), (405) 232-7663, Fax: (405) 552-5800, Fraud: (800) 899-1847

Oregon

State of Oregon—http://www.state.or.us/
Department of Consumer & Business Services—http://www.cbs.state.or.us/
350 Winter Street NE
Salem, Oregon 97301-3878
(503) 378-4100, Fax: (503) 378-6444

Workers' Compensation Division—http://wcd.oregon.gov/
350 Winter Street NE, Room 27
Salem, Oregon 97301-3879
(800) 452-0288 (Workers' Compensation Infoline); (503) 947-7810, Fax: (503) 947-7514; TTY: (503) 947-7993; Fraud Hotline: (800) 422-8778 (in Oregon); Small Business Ombudsman: (503) 378-4209, Fax: (503) 373-7639; Ombudsman for Injured Workers: (800) 927-1271, (503) 378-3351, Fax: (503) 373-7639

Workers' Compensation Board—http://www.cbs.state.or.us/wcb/
2601 25th Street SE, Suite 150
Salem, Oregon 97302-1282
(503) 378-3308

Workers' Compensation Management-Labor Advisory Committee—http://www.cbs.state.or.us/mlac/
Department of Consumer & Business Services
350 Winter Street, Room 200
Salem, Oregon 97301-3878
(503) 947-7867; Fax: (503) 378-6444

Ombudsman for Injured Workers— http://www.cbs.state.or.us/external/wco/index.html
350 Winter Street NE, Room 160
Salem, Oregon 97310
(800) 927-1271, (503) 378-3351

Ombudsman for Small Business—http://www.cbs.state.or.us/external/sbo/index.html
350 Winter Street NE
Salem, Oregon 97301-3878
(503) 378-4209, V/TTY: (503) 378-4100

SAIF Corporation—http://www.saif.com/
400 High Street SE
Salem, Oregon 97312-1000
(800) 285-8525, (503) 373-8000

Pennsylvania

State of Pennsylvania—http://www.state.pa.us/
Department of Labor and Industry—http://www.dli.state.pa.us/
Labor & Industry Building
Room 1700
7th and Forster Streets
Harrisburg, Pennsylvania 17120
(717) 787-5279
Bureau of Workers' Compensation—http://www.dli.state.pa.us/landi/cwp/view.asp?a=138&Q=58929&landiPNav=|#1026
1171 South Cameron Street, Room 324
Harrisburg, Pennsylvania 17104-2501
(800) 482-2383 (inside Pennsylvania), (717) 772-4447 (local/out of state), TTY: (800) 362-4228 (for hearing and speech impaired only)
E-mail: ra-li-bwc-helpline@state.pa.us
Click here to download free fillable PDF (Portable Document Format) versions of Pennsylvania workers' compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

State Workers' Insurance Fund—http://www.dli.state.pa.us/landi/cwp/view.asp?a=151&Q=58236&landiNavDLTEST=|852|1065|2548|
100 Lackawanna Avenue
Scranton, Pennsylvania 18503
(570) 963-4635

Workers' Compensation Appeal Board
1171 South Cameron Street, Room 305
Harrisburg, Pennsylvania 17104-2511
(717) 783-7838

Rhode Island

State of Rhode Island—http://www.state.ri.us/
Workers' Compensation Court—http://www.courts.state.ri.us/workers/defaultnew-workers.htm
One Dorrance Plaza
Providence, Rhode Island 02903
(401) 458-5000, Fax: (401) 222-3121

Department of Labor and Training—http://www.dlt.ri.gov/
1511 Pontiac Avenue
Cranston, Rhode Island 02920-4407
(401) 462-8000
Workers' Compensation Division—http://www.dlt.ri.gov/wc/
Street Address:
1511 Pontiac Avenue, Building 69, Second Floor
Cranston, Rhode Island 02920-0942
Mailing Address:
Post Office Box 20190
Cranston, Rhode Island 02920-0190
(401) 462-8100, Fax: (401) 462-8105, TDD: (401) 462-8006
Click here to download free fillable PDF (Portable Document Format) versions of Rhode Island workers' compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

South Carolina

State of South Carolina—http://www.myscgov.com/
Workers' Compensation Commission—http://www.wcc.state.sc.us/
Street Address:
1612 Marion Street
Columbia, South Carolina 29201
Mailing Address:
Post Office Box 1715
Columbia, South Carolina 29202-1715
(803) 737-5700, Fax: (803) 737-5768
Click here to download free fillable PDF (Portable Document Format) versions of South Carolina workers' compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

South Carolina State Accident Fund—http://www.myscgov.com/scoa/
Street Address:
800 Dutch Square Boulevard
Columbia, South Carolina 29221
Mailing Address:
Post Office Box 102100
Columbia, South Carolina 29221-5000
(800) 521-6576, (803) 896-5800

South Carolina Second Injury Fund
22 Koger Center
Winthrop Building, Suite 119220
Executive Center Drive
Columbia, South Carolina 29210
(803) 798-2722, Fax: (803) 798-5290

South Carolina Workers' Compensation Uninsured Employers' Fund
22 Koger Center
Winthrop Building, Suite 119220
Executive Center Drive
Columbia, South Carolina 29210
(803) 798-2722, Fax: (803) 798-5290

South Dakota

State of South Dakota—http://www.state.sd.us/
Department of Labor—http://www.state.sd.us/dol/dol.asp
Division of Labor and Management—http://www.state.sd.us/dol/dlm/dlm-home.htm
Kneip Building, Third Floor
700 Governors Drive
Pierre, South Dakota 57501-2291
E-mail: labor@dol-pr.state.sd.us
(605) 773-3681, Fax: (605) 773-4211

Tennessee

State of Tennessee—http://www.state.tn.us/
Department of Labor and Workforce Development—http://www.state.tn.us/labor-wfd/
Workers' Compensation Division—http://www.state.tn.us/labor-wfd/wcomp.html
710 James Robertson Parkway
Gateway Plaza, Second Floor
Nashville, Tennessee 37243-0665
(800) 332-2667 (within Tennessee), (615) 532-4812, Fax: (615) 532-1468
Click here to download free fillable PDF (Portable Document Format) versions of Tennessee workers' compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

Texas

State of Texas—http://www.state.tx.us/
Texas Workers' Compensation Commission (TWCC)—http://www.twcc.state.tx.us/
7551 Metro Center Drive, Suite 100
Austin, Texas 78744-1609
(512) 804-4000, Commissioners: (512) 804-4435 fax: (512) 804-4431, Customer Relations/Services: (512) 804-4100 or 804-4636, Fax: (512) 804-4001, Fraud Hotline: (512) 804-4703, Injured Worker Hotline/Ombudsman: (800) 252-7031, Safety Violations Hotline: (800) 452-9595
Click here to download free fillable PDF (Portable Document Format) versions of Texas workers' compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

Utah

http://www.state.ut.us/
Industrial Commission of Utah—http://www.ind-com.state.ut.us/
Industrial Accidents Division—http://www.ind-com.state.ut.us/indacc.htm
Post Office Box 146610
Salt Lake City, Utah 84114-6610
(801) 530-6800, Fax: (801) 530-6804

Workers' Compensation Fund of Utah—http://www.wcf-utah.com/
Salt Lake City Office
392 East 6400 South
Murray, Utah 84107
(800) 446-2667

Vermont

State of Vermont—http://www.state.vt.us/
Department of Labor & Industry—http://www.state.vt.us/labind/
National Life Building
Drawer 20
Montpelier, Vermont 05620-3401
(802) 828-2288, Fax: (802) 828-2195

Workers' Compensation Division—http://www.state.vt.us/labind/wcindex.htm
National Life Building
Drawer 20
Montpelier, Vermont 05620-3401
(802) 828-2286, Fax: (802) 828-2195
Click here to download free fillable PDF (Portable Document Format) versions of Vermont workers' compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

Virginia

Commonwealth of Virginia—http://www.virginia.gov/cmsportal/
Virginia Workers' Compensation Commission—http://www.vwc.state.va.us
1000 DMV Drive
Richmond, Virginia 23220
(877) 664-2566, Fax: (804) 367-9740, TDD: (804) 367-8600
E-mail: Questions@vwc.state.va.us
Click here to download free fillable PDF (Portable Document Format) versions of Virginia workers' compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

Washington

State of Washington—http://access.wa.gov/
Department of Labor and Industries—http://www.lni.wa.gov/
Labor and Industries Building
Post Office Box 44001
Olympia, Washington 98504-4001
(800) 547-8367, (360) 902-4200, Fax: (360) 902-4202

Board of Industrial Insurance Appeals—http://www.biia.wa.gov/
Street Address:
2430 Chandler Court, SW
Olympia, Washington 98504-2401
Mailing Address:
Post Office Box 42401
Olympia, Washington 98504-2401
(800) 442-0447, (360) 753-9646, Fax: (360) 586-5611
Click here to download free fillable PDF (Portable Document Format) versions of Washington workers' compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

Workers' Compensation Information—http://www.lni.wa.gov/ClaimsInsurance/ClaimsAppeals/GetClaimInfo/default.asp

West Virginia

West Virginia—http://www.wv.gov/
Workers' Compensation Commission—http://www.wvwcc.org/
Mailing Address:
Post Office Box 3824
Charleston, West Virginia 25338-3824
Street Address:
4700 MacCorkle Avenue, SE
Charleston, West Virginia 25304
(800) 628-4265, (304) 926-5060, Fax: (304) 926-5372, Fraud: (800) 779-6853 or lprater@wvbep.org

Workers’ Compensation Commission Board of Managers

Workers' Compensation Office of Judges—http://www.wvwcc.org/ooj/
Mailing Address:
Post Office Box 2233
Charleston West Virginia 25328-2233
Street Address:
One Players Club Drive
Charleston West Virginia 25311
(304) 558-1686, Fax: (304) 558-1021

Workers' Compensation Board of Review—http://www.state.wv.us/bep/AppBd/
Mailing Address:
Post Office Box 2628
Charleston, West Virginia 25329-2628
Street Address:
104 Dee Drive
Charleston, West Virginia 25301
(304) 558-5230, Fax: (304) 558-1322

Wisconsin

State of Wisconsin—http://www.wisconsin.gov/state/home
Department of Workforce Development—http://www.dwd.state.wi.us/
Workers' Compensation Division—http://www.dwd.state.wi.us/wc/default.htm
Mailing Address:
Post Office Box 7901
Madison, Wisconsin 53707-7901
Street Address:
Room C100
201 East Washington Avenue
Madison, Wisconsin 53703
(608) 266-1340; Fax: (608) 267-0394; Fraud (608) 261-8486
Click here to download free fillable PDF (Portable Document Format) versions of Wisconsin workers' compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

Workers' Compensation Advisory Council—http://www.dwd.state.wi.us/notespub/wcadvcou/
(608) 266-6841

Wisconsin Compensation Rating Bureau—http://www.wcrb.org/
Mailing Address:
Post Office Box 3080
Milwaukee, WI 53201-3080
Street Address:
20700 Swenson Drive, Suite 100
Waukesha, Wisconsin 53186
(262) 796-4540, Fax: (262) 796-4400

Wisconsin Labor and Industry Review Commission—http://www.dwd.state.wi.us/lirc/
Mailing Address:
Post Office Box 8126
Madison, Wisconsin 53708-8126
Street Address:
Wisconsin Public Broadcasting Building
3319 West Beltline Highway
Madison, Wisconsin
(608) 266-9850 Fax: (608) 267-4409
E-mail: dwdlirc@dwd.state.wi.us

Wyoming

State of Wyoming—http://www.state.wy.us/
Department of Employment—http://wydoe.state.wy.us/

Cheyenne Business Center
1510 East Pershing Boulevard
Cheyenne, Wyoming 82002
(307) 777-7672, Fax: (307) 777-5805
Cindy Pomeroy, Director, (307) 777-5960, CPOMER@state.wy.us
Charles Rando, Administrator, (307) 777-6370, CRANDO@state.wy.us

Workers' Safety and Compensation Division—http://wydoe.state.wy.us/doe.asp?ID=9
Cheyenne Business Center
1510 East Pershing Boulevard
Cheyenne, Wyoming 82002
(307) 777-7159, Fax: (307) 777-5524.
    To Report an Injury: (800) 870-8883 or (307) 777-7441, Fax: (307) 777-6552.
    To Report Fraud: (888) 996-9226 or (307) 777-6552, Fax: (307) 777-3581.
    Gary Child, Administrator, (307) 777-7159, Fax: (307) 777-5524, GCHILD@state.wy.us

Employment Tax Division—http://wydoe.state.wy.us/doe.asp?ID=10
Post Office Box 2760
Casper, Wyoming 82602-2760
(307) 235-3201 (Casper) or (307) 777-7471 (Cheyenne)

Other U.S. Areas

American Samoa

American Samoa—http://members.aol.com/pologa/welcome.html
Workmen's Compensation Commission
Office of the Governor
Pago Pago, American Samoa 96799

Guam

Guam-http://www.gov.gu/
Department of Labor
Workers' Compensation Commission
Government of Guam
Post Office Box 9970
Tamuning, Guam 96931-9970
(671) 647-4205, Fax: (671) 649-4922

Navajo Nation

Navajo Nation—http://www.navajo.org/
Workers' Compensation Program
Post Office Box 2489
Window Rock, Arizona 86515
(928) 871-6389, Fax: (928) 871-6087

Northern Mariana Islands

Puerto Rico

Puerto Rico—http://fortaleza.govpr.org/ingles/govwel.htm
Industrial Commissioner's Office
G.P.O. Box 364466
San Juan, Puerto Rico 00936
(787) 783-3808, Fax: (787) 783-5610

State Insurance Fund
G.P.O. Box 5028
San Jaun, Puerto Rico 00936

Virgin Islands

Virgin Islands—http://www.usvi.org/
Department of Labor—http://www.vidol.gov/
St. Croix (Main Office)
302 King Street
St. Croix, Virgin Islands 00840-4612
(340) 773-1994, Fax: (340) 772-3365
St. Thomas (Main Office)
Post Office Box 302608
St. Thomas, Virgin Islands 00803-2608
(340) 776-3700, Fax: (340) 774-5908
Workers' Compensation Administration—http://www.vidol.gov/Units/Workers_Compensation/Workers_Comp.htm
3012 Vitraco Mall, Golden Rock
Christiansted
St. Croix, Virgin Islands 00820-4666
(809) 692-9390, Fax: (809) 773-4338