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Claim Forms

We always encourage our Safety Group Members to contact us when an incident occurs in the workplace so we can best advise you on how to proceed. But just in case, here are some commonly used links to report a claim, form you may need to complete, or record an incident.


All Workers' Compensation claims are to be submitted electronically using eFroi (Electronic First Report of Injury)


Employers must provide a copy of the Claimant Information Packet to any employee who will be filing for Workers' Compensation 

Contract Review

Additional forms for Employers to complete which will be required by the carrier for a claim including C-11,
C-107, & C-240

Medical form with stethoscope

Employers should maintain documentation of all workplace incidents even when choosing to self-retain or the injury does not need to be reported


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Tel: 201-652-2015

Fax: 201-652-4936

 Innovative Risk Concepts, Inc.

179 S. Maple Ave.

Ridgewood, NJ 07450

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