INJURED EMPLOYEES MUST CALL
GALLAGER BASSETT PC365 TRIAGE NURSE
(855) 715-2039

REPORTING REQUIREMENTS:

Employee: Contact Gallagher Bassett PC365 Triage Nurse at (855) 715-2039 within 24 hours and provide information as required. They will recommend a treatment plan.

Employer: Ensure report of injury is made within 5 days of notification – failure to do so could result in a fine and possible policy cancellation. The filing of reporting forms is not an admission of employer liability. Report objective information as reported to you.

EMPLOYER DUTIES:

• Provide employee reporting forms as required by state.
• Employees should sign forms as required.
• File forms as required and comply fully with your duties as described in PART FOUR – YOUR DUTIES IF INJURY OCCURS of your workers compensation policy.
• File a report even if the employee prefers not to see a physician.

Reporting instructions

All First Report of Injury forms are available via our website: https://cimarroninsurance.com/wc-policy-resources/ under File A Claim.

For guidance, contact Gallagher Bassett at (855) 715-2039 to speak with a claims representative.

Cimarron Insurance Company (040264)

c/o Gallagher Bassett
P.O. Box 2934
Clinton, IA 52733-2934
Email: cimarronclaims@mvsc.com