How to file your workers' compensation claim

The information below will help your claims adjuster and agent to begin processing your claim.

Work related injury

Immediately following a work-related injury:

1. Complete the Employer's First Report of Injury Form
2. Save and print two copies of the form. Keep one for your record and send one to Rural Mutual Insurance Company via:
   • Fax: 800-410-5895
   • Email: sf@ruralins.com
   • Mail: Rural Mutual Insurance Company
     Claims Department
     P.O. Box 5555
     Madison, WI 53705-0555

Note: Do not withhold the loss report for any reason. Even if you do not have all the information (medical bills, etc.) or the claim is questionable, send the report immediately.

Work related death

Within 24 hours of a work-related death:

1. Complete the Employer's First Report of Injury Form
2. Save and print three copies:
   • Keep one for your records
   • Fax one copy to the State of Wisconsin
     Fax: 608-260-2503
   • Send one copy to Rural Mutual
     • Fax: 800-410-5895
     • Email: sf@ruralins.com
     • Mail: Rural Mutual Insurance Company
       Claims Department
       P.O. Box 5555
       Madison, WI 53705-0555

Note: Reporting a loss is not an admission of liability. However, your failure to promptly send the WKC-12-E Form to Rural Mutual could result in your paying a penalty. Our claims adjusters are required by law to make the initial time-lost payment within 14 days of the date of injury or beginning of disability.

OSHA requires that they be notified at 1-800-321-OSHA within 8 hours of a fatality and/or hospitalization of three or more employees from the same incident.

Suspect Workers' Compensation fraud?

• Report here
• Learn the warning signs