Reporting a Claim

Time is of the essence when there’s an injury. Same goes for reporting a claim.

Form 5020

  • Complete the Employers’ Report of Occupation Injury (Form 5020) to the best of your ability and only if you’re reporting a claim via fax. If you report a claim via telephone or online the Form 5020 will automatically be completed.
  • Submit the form in one of the four ways within 24 hours of the injury, even if you don’t have all of the claim details.

Live Operator

Call 1.800.474.8080 24/7 for assistance from a live operator.

Send a Fax or Email

Fax your completed Form 5020 to 1.800.858.6509 or email to claims@actec.net.