Materials
Request Form

materals request form

Example: WSD-1234567 You can find your policy number on your billing statement, policyholder welcome email, or printed Claims Kit.

To what corporate business address should we mail these materials?

Which materials are you requesting?

Full Kit
Policyholder Perks
Quick Start Checklist
How to Report a Claim
California Employer's First Report
Facts about Work Comp (English)
OSHA Notice
False Claims Ticket
10 Red Flags of Fraud Flyer
California MPN Information
CA MPN Medical Authorization Form
CA First Aid Information
Fraud Alert Posters (English and Spanish)
Prescription Information
Take a BITE out of Fraud Poster
Please request labor law posters and OSHA-related materials from your state's labor department.

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If you experience difficulties submitting this form, simply print and fax to:

ICW Group
Attn: Workers’ Compensation Underwriting
Fax: 858.350.2616

Notice of Collection of Personal Information