Workers’ Compensation Claim Kit – Louisiana

Who will handle your claims?

The Dallas Regional Claim Office will handle your Louisiana claims.

Phone: 800-527-5531
Mike Hicks, AVP

Please direct all general correspondence to:

Fax:        877-622-6911
Mail:      PO Box 14139
Lexington, KY  40512

How to Report Workers’ Compensation Claims?
To report via the Internet: Log on to the Crum & Forster website at Use your assigned User ID and Password. If you do not have a current User ID, please contact your local Crum & Forster Claims or Marketing resource.

To report e-mail:
To report via fax: 1-877-622-6218
To report claims via telephone: 1-800-690-5520

(7 day/24 hour toll free reporting line for all states)

  • In the event of a serious or fatal injury, notify the local claim office immediately by telephone.


What forms does the employer need to be aware of?

Click on this link for the Louisiana Forms:

LDOL-WC 1007 / Employer’s Report of Injury or Illness
If you report the claim via telephone, you do not need to fill out this form.
If you report the claim via fax, complete the form, and fax it to the following Crum & Forster fax number – fax# 1-877-622-6849.


LDOL-WC 1121 / Doctor Choice Form
This form explains an injured employee’s right to select his treating physician.

La-Physician Choice Form

SIB Form D / Second Injury Fund Employer Knowledge Questionnaire
The attached questionnaire should only be completed by individuals that have been hired for employment and may be used in establishment of prior knowledge for the purpose of obtaining Second Injury Fund relief from the Second Injury Board.

English version Spanish Version

LA Knowledge Questionnaire 10-17 LA Spanish Knowledge Questiona

Frequently Asked Questions
This includes answers to the employer’s and employee’s most frequently asked questions and concerns relating to Louisiana’s workers’ compensation entitlement procedures.

What is the Waiting Period for Lost Wages in Louisiana?
The waiting period is 7 days. If the employee is off for over 6 weeks, the 1st 7 days is paid retroactively.

What is the Choice of Physician Rule in Louisiana?

The employee has the right to choose a treating provider without restriction in each specialty to treat a compensable injury. The employee needs the employer/insurance carrier permission to change a treating provider within the same specialty. In order to make this request, employee must complete the attached Physician Choice Form.

LA PhysicianChoiceForm

Where should all medical bills be sent?

Crum & Forster
PO Box 14801
Lexington, KY 40512

Important Websites

Louisiana Office of Workers’ Compensation

Louisiana W/C Forms

Multi-State Information