Report An Injury

How to Report an Accident/Injury

  1. Within 24 hours of accident, injury or illness – via FHM website, call, fax, or email a state-approved, completed First Report of Injury or Illness to FHM. Whenever possible it is best to have the injured employee’s supervisor or those most knowledgeable with the details of the accident report the injury.
    1. Submit Online
    2. Email to: claimreporting@fhmic.com
    3. Call 888-346-3461, Option 1
    4. Fax to (407-352-5788)
  2. Have the following information ready:
    1. Injured employee information:
      1. Full name, address and telephone number;
      2. Occupation, date of birth and sex;
      3. Social Security number; and
      4. Hire date
    2. Date and time of accident.
    3. Employee’s description of accident. If a language barrier is present, please have a bilingual employee interpret as needed so you can provide the most accurate and complete information possible.
    4. Injury/illness that occurred, part of body injured. Please be specific about what occurred.
    5. Company name, telephone and address.
    6. Employer’s location address if different from above.
    7. Place/address accident/injury occurred.
    8. Federal Employer ID# and FHM policy number; (i.e., WC-306 –xxxxx).
    9. Did the employee return to work?
    10. Do you (the employer) agree with the employee’s description of the accident?
    11. Name of physician or hospital where employee was sent by you for treatment.

View FHM Insurance Company's profile on LinkedIn