Workers Compensation Claims

To notify us of an event relating to a claim please fill this form with the most accurate details of the event possible. A confirmation of this submission and a copy of your responses will be emailed to the Reporter's email address upon completion and submission of the form.
If you have any further inquiries please call us on 1800 810 213

Are you a:*



Type of Notification*



Is the Employer registered for GST?*
Has an input tax credit for the GST included in the insurance policy premium been claimed?*
Was the amount of GST claimed less than 100% of the GST included in the premium?



Is an interpreter required?*
Employment status







Were there any Witnesses?