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?*

 


 

Is an interpreter required?*
Employment status

 


 

 


 

 


 

Were there any Witnesses?