Greenville, South Carolina

File a Workers Comp claim

Please fill out the form below and a representative will be in touch within 24 hours.

Date and Time of occurrence
Date Picker
Company Information
Occurrence Information
Loss Information

Injured / Property Damage

Witnesses

Witnesses

By submitting this form I agree that all of the included information is truthful to the best of my knowledge and I understand that fraudelent claims are illegal and may be prosecuted. Statewide Group's acceptance of this form does not constitute confirmation of coverage.

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