Reporting Non-Industrial COVID Cases

• Retroactive reporting: All positive COVID tests between 7/6/20 to 9/16/20 must be reported, whether it is an industrial or non-industrial COVID case.
• Current and ongoing reporting: All positive COVID cases, whether industrial or non-industrial, between 7/6/20 and 1/1/23 must be reported within 3 business days of knowledge.

Workers’ Compensation COVID Specific Reporting Forms & Information:

---

AmTrust Insurance:

COVID Tracking Form

---

Benchmark Insurance:

COVID Tracking Form  |  Email to: nonwccovid@bmaclaims.com

---

BHHC:

COVID Tracking & Information for Policyholders  |  Email to: CovidReporting@bhhc.com

---

CompWest Insurance:

COVID Tracking Form  |   Email to: COVID19@AFGroup.com or Fax: 844-618-3636

---

Employers:

COVID Tracking Form  |  Email to: reportaclaim@employers.com or Fax: 775-886-1725

---

Hartford:

COVID Tracking Form (7/6/20 – 9/16/20)  |  COVID Tracking Form (9/17/20 – 1/1/23)  |  Resource Page  |  Email to: LossConnect@TheHartford.com or Fax: 800-347-8197

---

ICW:

COVID Tracking Form  |  Email to: firstnotice@icwgroup.com or Fax: 858-436-8916

---

Midwest:

COVID Tracking Form  |  Email to: caclaims@midins.com or Fax: 866.642.1234

---

Pacific Comp:

COVID Tracking Form (7/6/20 – 9/16/20)  |  COVID Tracking Form (9/17/20 – 1/1/23)  |  Email to: COVIDREPORTS@pacificcomp.com

---

Preferred Employers:

COVID Tracking Form  |  Email to: firstreport@peiwc.com or Fax: 866-921-7313

---

Republic Indemnity:

COVID Tracking Report  |  Email to: SB1159@ri-net.com or Fax: 866-448-1159

---

State Fund:

COVID Tracking Form  |  Resource Page  |  Email to: COVID@scif.com or Fax: 800-325-1284

---

The Zenith:

COVID Tracking Form (7/6/20 – 9/16/20)  |  COVID Tracking Form (9/17/20 – 1/1/23)  |  Email to: COVID1159Reporting@thezenith.com

---

Travelers:

COVID Tracking Form  |  Email to: covidexposure@travelers.com