MAISL Workers’ Compensation Claims

REPORT YOUR CLAIM ONLINE:

To report a claim online please CLICK HERE

REPORT YOUR CLAIM BY FAX:

Download The Employer’s First Report of Injury Form [ Word / PDF ]

Other Downloadable PDF forms:

  • Incident Report (For all lost time claims) [ Word ]
  • Order for Medical Treatment (If required for clinic referral) [ Word ]
  • Mileage log [ Word / PDF ]
  • Payroll worksheet (If payroll records are not electronic) [ Word / PDF ]

Reporting Procedures:

  • WC Claims Reporting Procedures [ PDF ]
  • MAISL Claims Contact List [ PDF ]
  • Short Form Instructions [ PDF ]
  • MAISL Points to Remember [ PDF ]

3 yellow rings on left next to the words MAISL Workers' Compensation Fund

For questions or support using these documents, please contact:

Connie See
Reg. Claims Manager, AVP
Toll Free: (800) 752-7477
Fax: (616) 942-0390
connie.see@meadowbrook.com

Share:

3 yellow rings on left next to the words MAISL Workers' Compensation Fund

For questions or support using these documents, please contact:

Connie See
Reg. Claims Manager, AVP
Toll Free: (800) 752-7477
Fax: (616) 942-0390
connie.see@meadowbrook.com