Use the link below to complete the Loss Notice. Once the information is entered, be sure to indicate “yes” and enter the email address that the Loss Notice information and DWC-1 should be emailed to.
DWC-3 and DWC-6 forms may be entered at the above link as well.
If you have a username and need help resetting your password, contact the Help Desk at 866-647-7610, option 2 (Monday-Friday 7:00-7:00). You may also email email@example.com.