Stonetrust

EMPLOYER REPORT OF INJURY/ILLNESS

Use the appropriate form for your state to report a claim. You will need Adobe Reader 7.0 in order to download and save the PDF version.

ARKANSAS First Report of Injury/Illness Form (PDF)
LOUISIANA First Report of Injury/Illness Form (PDF)
MISSISSIPPI First Report of Injury/Illness Form (PDF)
OKLAHOMA First Report of Injury/Illness Form (PDF)
TEXAS First Report of Injury/Illness Form (PDF)

Your claim can be reported by phone, fax or mail. Upon receipt of your claim, we will file the appropriate documents with the proper regulatory authorities in your state.

BY PHONE: Call (800) 311-0997, ext. 2009 or 2017, and our staff will be happy to complete the paperwork for you. Please allow ample time for the claims specialist to gather all the information from you.

BY FAX: Complete the appropriate new claim form and fax it toll free to (866) 923-1871.

BY MAIL: Complete the appropriate new claim form and mail it to us at:
400 NORTH TRENTON, SUITE 200
RUSTON, LA 71270

Please report all claims to us immediately to ensure prompt investigation and payment of benefits. A delay in payment of benefits may result in the assessment of penalties. Drug testing should be completed on the day of the accident.

All accidents must be reported to Stonetrust Management Services. The State may assess a penalty against your company if claims with disability are not reported to them within ten (10) days of the accident.

Employer resources Calculating Premium Reporting Payroll Experience Modifiers Payroll Audits Employment Policies claims Reporting Claims Claims Tips Preventing Fraud Loss Control Site Visits Safety Programs ONLINE FORMS Underwriting Claims Employers News Find an Agent Contact Us >> Home	EMPLOYER REPORT OF INJURY/ILLNESS Use the appropriate form for your state to report a claim. You will need Adobe Reader 7.0 in order to download and save the PDF version. ARKANSAS First Report of Injury/Illness Form (PDF) LOUISIANA First Report of Injury/Illness Form (PDF) MISSISSIPPI First Report of Injury/Illness Form (PDF) OKLAHOMA First Report of Injury/Illness Form (PDF) TEXAS First Report of Injury/Illness Form (PDF) Your claim can be reported by phone, fax or mail. Upon receipt of your claim, we will file the appropriate documents with the proper regulatory authorities in your state. BY PHONE: Call (800) 311-0997, ext. 2009 or 2017, and our staff will be happy to complete the paperwork for you. Please allow ample time for the claims specialist to gather all the information from you. BY FAX: Complete the appropriate new claim form and fax it toll free to (866) 923-1871. BY MAIL: Complete the appropriate new claim form and mail it to us at: 400 NORTH TRENTON, SUITE 200 RUSTON, LA 71270 Please report all claims to us immediately to ensure prompt investigation and payment of benefits. A delay in payment of benefits may result in the assessment of penalties. Drug testing should be completed on the day of the accident. All accidents must be reported to Stonetrust Management Services. The State may assess a penalty against your company if claims with disability are not reported to them within ten (10) days of the accident.	Employer Downloads First Report of Injury Claims Reporting Guide Second Injury Questionnaire Employment Documents Fraud Guide and Poster Safety Program Components Safety Tips and Checklists OSHA Recordkeeping UNDERWRITING DOWNLOADS Underwriting Guide ACORD Application Contractor Supplemental #210 Owner/Officer Exclusion #211 Convenience Store #212 Automobile Exposure #213 Trucking Supplemental #214 ERM-14 Change in Ownership Policyholder Address Change Cancellation Request You will need to have Adobe Acrobat Reader version 7.0 or higher software to view these .PDF files on your computer. If you do not have the latest Adobe Acrobat Reader, click the icon to visit the Adobe website to download a free copy of Adobe Acrobat Reader.
© 2006 Stonetrust Commercial Insurance Co.