Industrial Accidents Division

Carrier Contact Form

Workers' Compensation Carrier Contact Form.  EDI POC & EDI Claims Contacts must be an Employee of the Carrier / Self-Insurer and NOT a Claim Administrator.  We use this contact information for legal services.

Carrier Information

POC EDI Primary Contact (Employee of Carrier)

POC EDI Secondary Contact (Employee of Carrier)

Claims EDI Primary Contact (Employee of Carrier)

Claims Contact for Public Use

Submitter Information