Report a Workers Compensation Claim:
Immediately following a work-related injury, complete the Employer's First Report of Injury Form (WKC-12 form).

Note: You can fill out the form on your computer and print it. No need to enter the information by hand.

1. Upon completion of the WKC-12-E Form, immediately print 2 copies (1 for your records) and send to Rural Mutual Insurance Company via one of the following methods:

• Fax: 1-800-410-5895
• 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.

2. Within 24 hours of a work-related death, complete the Employer's First Report of Injury Form (WKC-12 form) and report it to both the State of Wisconsin (via fax at 608-260-2503) and Rural Mutual (via one of the methods listed above).

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.

Report Fraud:
To report fraudulent activity, contact us at (800) 362-7881, ext. 484 or click on Fraud Report.

To learn more about workers compensation fraud, go to the Warning Signs.

Contact Information:
If you have any questions about your Workers Compensation policy or filing a report, please contact Rural Mutual’s Workers Compensation Claims Office at (800) 362-7881, ext. 484.