For your convenience and to help you comply with the law, we compiled the forms you’ll need to file a claim in an electronic claim kit (PDF). The chart below lists the forms and when to distribute them. You can also view and download the individual forms below:
| Forms to File A Claim | Policy Inception | Time of Injury |
| Workers’ Compensation Claim Form e3301 with instructions |
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| Employer’s Report of Occupational Injury or Illness 3067 Must be completed and submitted to State Fund no later than 5 days from the date of knowledge of a work injury or illness. |
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| Employee’s Guide to State Fund MPN e3851 Must be posted at every worksite in a location that is easily visible to your employees. Must also be provided to employee at time of injury or, where there is existing injury, and when transferring care into MPN. |
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Please refer to the Employer Requirements page for a list of documents required to post and distribute to employees at the time of policy inception and at the time of hire.
If you have additional questions, please call our Customer Support Center at 888-STATEFUND (888-782-8338).
