First Report of Injury

CompManagement Health Systems, Inc. cares about the workers and employers and we´re working hard to the take the mystery out of the workers compensation claim process. CHS realizes that an on-the-job injury can have far-reaching impacts to you and your family. That´s why we´ve made filing a claim quick and easy. The First Report Of Injury (FROI) is the application used to initiate a workers´ compensation claim and it´s now available online.

Required Information:

If you are an Employer:

• Injured Worker Name
• Injured Worker SSN
• Injured Worker Mailing Address
• Injured Worker Home or Work Phone
• Number
• Date of Birth
• Date of Injury/Disease
• Gender
• Occupation or Job title

• Description of Accident
• Type of Injury/Disease and Part(s) of Body Affected
• Employer Policy Number (lookup function provided)
• Place of Accident or Exposure on Employer´s Premises
• Date Hired
• Type of Injury/Disease and Part(s) of Body Affected
• Date Employer Notified

If you are an Injured Worker:

• Injured Worker Name
• Injured Worker SSN
• Injured Worker Mailing Address
• Injured Worker Home or Work Phone
• Number
• Date of Birth
• Date of Injury/Disease

• Gender
• Occupation or Job title
• Description of Accident
• Type of Injury/Disease and Part(s) of Body Affected
• Employer Policy Number (lookup function provided)

Submit FROI to CompManagement Health Systems online.

Print the FROI form and fax to CompManagement Health Systems, Inc at 1-800-334-4229.

Click here for Instructions on Complete the FROI