Workers' Compensation Claims Forms

Manual Forms to Submit via Email

If a member cannot use the online claim submission tool, they can submit completed claims forms by emailing them to with a copy to

Online Workers' Compensation Claim Submission


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.

Access for New Users

New users need to request access to Juris Global Intake to submit claims online by emailing a completed  Juris Global Intake Request Form to

For Technical Assistance

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

More Workers' Compensation Information on WC Notices Page

Learn More