Claims Forms

Form 18:
Notice of Accident to Employer and Claim of Employee, Representative or Dependant

Form 19:
Employer's Report of Employee's Injury or Occupational Disease to the Industrial Commission

Form 22:
Statement of Days Worked and Earnings of Injured Employee

Form 25T:
Itemized Statement of Charges for Travel


Product Overview

Contact Us

Toll-Free:
(800) 869-3999

Email:
info@iSurity.com

iSurity
PO Box 6455
High Point, NC 27262

Phone: (336) 869-3000
Fax: (336) 869-7070