When injuries happen. 

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About AmFed Contact
Report an Injury

NOTIFY US OF A CLAIM > Reporting forms can be found in your policy packet and on our website below.  Upon receipt of your claim, we will file the appropriate documents with the proper regulatory authorities in your state.

 

Email - FROl@amfed.com

Phone - (866) 866-9199 

Fax -  (601) 427-1588 / (844) 263-3311

Mail - Post Office Box 1380, Ridgeland, Mississippi 39158

 

WHEN TO NOTIFY US > 
  •  Within 24 hours of an accident or alleged accident
  •  Immediately in the case of serious or fatal injury
  •  Immediately upon receipt of motions and lawsuits
  •  Immediately when an injured employee returns to work
  •  If you have any information which suggests a questionable or fraudulent claim
  •  If you have knowledge of a pre-existing medical condition of the injured employee
  •  Prior to all recommended medical treatment and/or diagnostic testing Important

Please report all claims to AmFed immediately to ensure prompt investigation and payment of benefits as a delay may result in penalties. The wage information section on the claim reporting form must be completed on claims with disability or anticipated disability (used to establish the compensation rate). 

 

IMPORTANT TIPS >

  • Keep AmFed promptly informed of any information regarding a claim 
  • The state may assess a penalty against your company if claims are not reported within eight (8) days of an accident
  • Drug testing should be completed the day of the accident
  • Document any pre-existing injuries with a post-hire Second Injury Medical Questionnaire on all Louisiana Employees
  • Establish effective employment policies and maintain personnel records
FIRST Report OF Injury Forms (by State) > 
Arkansas
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  • AmFed First Report of Injury AR (PDF)
Georgia
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  • GA First Report of Injury (PDF)
Indiana
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  • First Report of Injury Form (PDF)
Kentucky
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  • KY FROI (PDF)
Louisiana
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  • LWC WC IA 1 First Report of Injury (PDF)
Mississippi
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  • first report of injury MS (PDF)
North Carolina
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  • NC 1st report (PDF)
South Carolina
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  • First Report of Injury (DOC)
Tennessee
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  • AmFed First Report of Injury TN (PDF)
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