Fraud Investigation Referral

Please use this form to report employer/business (include owner's full name), injured worker (employee), and provider workers' compensation fraud. All information on this form will be held in strict confidence by Workforce Safety & Insurance.

Information on Reported Party

In this section, please list information related to the party being reported for the suspected fraudulent activity.

Please provide your information below so we may contact you to acquire additional information. We will maintain your anonymity.

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