Workers’ Compensation Claim Kit – Utah

Who will handle your claims?

The Dallas Regional Claim Office will handle your Utah claims.

Phone: 800-527-5531
Mike Hicks, AVP

Please direct all general correspondence to:

Email:    [email protected]
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: [email protected]

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?

Form 122 / Employer’s First Report of Injury:

If you report the claim via the Internet or by telephone, you do not need to fill out this form. If you report the claim via fax, complete this form, and fax it to Crum & Forster at the fax number provided above.

UT-Employer First Report of Injury

What is the Waiting Period for Lost Wages in Utah?
The waiting period is 3 days. If the employee is off for over 14 days, the 1st 3 days is paid retroactively.

What is the Choice of Physician Rule in Utah?
The employer/insurer has the right to select the initial treating provider. If this right is not exercised, the employee is free to make the choice.

Preferred Provider Organization Network (PPO):

Crum & Forster has a PPO network available. Follow the instructions below to access the PPO Network:

Logon to the website at:

  • Search by Provider Address, Name or Region
  • Select the Distance, Provider Type and Specialty
  • Results can then be exported to a directory or excel.
  • You can obtain a Map List or text message by selecting a specific provider

Where should all medical bills be sent?

Crum & Forster
PO Box 14801
Lexington, KY 40512

Important Websites:

Labor Commission of Utah-

Utah WC Forms-

Multi-State Information-