Please upgrade your browser to IE 11 or download Chrome for a better experience while viewing our site.

Online account access will be unavailable on March 3rd from 9pm-1am CST.

Workers' Compensation

Report a Claim

Did you know you can log in to My COUNTRY to report your claim? It is fast, your claim is assigned to a representative immediately, and you can view your claim status throughout the process. It may take up to 2 business days to assign yourclaim using the form below. To report other types of claims, visit our Claim Support Center.

Required fields are marked with an asterisk (*)

Contact Information

You'll enter the injured employee information later.



Loss Information


Location of loss

Injured Employee Details


Were medical services provided?
Did the injury result in a fatality?
Did the employee miss any workdays?