FAQ & Contact Information

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Online Employee Claim form page 

Welcome to our easy, guided online Employee Claim Form.
Attorneys MUST login and use the Claim form with Entry of Appearance.

Here are a few important tips:

  • You must enter a valid email address to receive status information
  • You must disable pop-up blocker on your web browser
  • The green text will help you
  • A red “X” message will identify a mistake
  • A red asterisk * means required information
  • The left column navigation shows your progress and lets you move back and forth
  • The claim must be completed in English.

CLICK HERE to get started or look below for more information.

Page with help labels
  • Add your signature with your mouse, touch screen/touchpad or download, print, sign, scan and upload
  • Save your information and submit it later
  • Scan/upload only the signed page 2 Medical Authorization. 
    DO NOT scan or upload the personal file copy of the claim form marked DO NOT FILE
  • Name your upload file simply, no periods or other symbols
  • Use Print a Copy to preview and print a copy of the completed form for your records before you submit the claim.
    You cannot access the claim after it is submitted
  • Use the Check Form Status tab to research the status of any claim started in the past 45 days.

You will receive an email

  • after you complete/save the Injured Worker Information
  • after the claim is submitted
  • if the claim is not accepted for processing.

When your claim has been accepted and processed, you will receive the Notice of Claim C-30 via US Postal Service mail.

All claim applications not submitted within 30 days are dismissed/deleted.

For technical assistance, contact

For other questions, please contact our Public Service office, or via telephone 410-864-5100 during normal business hours.