Workers' Compensation

Workers' Compensation First Report of Injury Forms and Additional Documents

First Report of Injury forms are state specific. Click on your state to open the appropriate form and other related documents.

When you have completed the necessary forms, you can submit them to Church Mutual via fax at (715) 539-4651 or by mail at Church Mutual Insurance Company, P.O. Box 342, Merrill, WI 54452-0342.
 

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Church Mutual Insurance Company
P.O. Box 357 | 3000 Schuster Lane | Merrill, WI 54452-0357
Telephone (800) 554-2642 or (715) 536-5577

© 2018 Church Mutual Insurance Company. All rights reserved. Protecting the Greater Good is a registered trademark of Church Mutual Insurance Company.