Extraordinary care for real people

Expert Claims Management

When an accident, injury or work-related illness prompts a claim, iSurity’s Claims Management Specialists represent your company and assist your employees with an unmatched balance of professionalism and compassion.

Services include:

  • Thorough investigation for evaluation of compensability and management of your Experience Rating (MOD)
  • Medical Care directed to the best possible provider, no exceptions
  • 3 Point Contact – established within 1 business day of receipt of every claim
  • 24–Hour Claims reporting

    Online or by phone

  • Pharmacy program

Report a claim

What to do when an employee is injured

1. Direct the injured employee to a local urgent care or hospital (provide the Panel of Physicians if applicable).

2. Report the claim to iSurity by completing a first report of injury—online, by phone, fax or email.

Submit a First Report of Injury for a new workers comp claim by one of the options below:

  • Online HERE in the Policyholder Portal
  • Email claims@isurity.com
  • Call (336) 869-3000 or 1-800-869-3999 to report the claim over the phone
  • Fax to (336) 869-7064

Download a printable First Report of Injury

3. When the injured worker returns, send a copy of all documents from the medical provider to iSurity.

4. Give the injured worker a temporary prescription card if needed.

Prescription Cards
iSurity offers temporary pharmacy/prescription cards.  This card allows an injured worker to receive a temporary supply of medication after the injury without any out-of-pocket expenses. Once the claim is received by iSurity, a permanent card will be issued, if applicable. 
     *Please contact our Claims Department if a supply of temporary cards is needed.


NC Forms
Form 17 - Notice to Injured Workers and Employers
Form 18 - Notice of Accident to Employer and Claim of Employee, Representative or Dependant 
Form 19 - Employer’s Report of Employee’s Injury or Occupational Disease to the Industrial Commission
Form 22 - Statement of Days Worked  and Earnings of Injured Employee
Form 25T - Itemized Statement of Charges for Travel

VA Forms 
VA Form 3 - Employer's Accident Report 
VA Form 7A - Wage Chart

GA Forms 
WC-1 - Employer's Accident Report
WC-6 - Statement of Days Worked and Earnings of Injured Employee 

TN Forms 
C20 - Employer's Accident Report  
C41 - Statement of Days Worked and Earnings of Injured Employee 

PA Forms 
Employer's Accident Report
Employee's Statement of Injury
LIBC-494C - Statement of Days Worked and Earnings of Injured Employee