Report Workers' Compensation Fraud

Please complete the form below to the best of your ability. Fields marked with an asterisk (*) are required.

Select a State *
What type of suspected fraud are you reporting? *	Injured Worker Fraud Employer/Premium Fraud Health-Care Provider Fraud
Name of company or person you are reporting: *
Address of company or person you are reporting:
If you are reporting an injured worker please provide any of the following information you have:	Race * Sex * DOB Approximate Age *
Describe why you think this person is committing workers' compensation fraud. *

If the individual you are currently reporting is working, please list any details you have regarding the employment (name of company, address, telephone number).

To be contacted by our office, please give us your name, address, telephone, and/or email address. You may remain anonymous but this may limit the scope of the investigation.