ABOUT US POLICYHOLDER CLAIMS SAFETY OPERATIONS AGENTS NEWS/EVENTS CONTACT CONTACT Contact Us Reporting Fraud Careers MAILING ADDRESS 5615 CORPORATE BLVD SUITE 800 BATON ROUGE, LA 70808 CONTACT INFO Toll free : 800.311.0997 local number : 225.923.1050 toll free fax : 866.923.1871 CONTACT FORM NEED HELP ? CONTACT US ADDRESS 5615 Corporate Blvd Suite 800 Baton Rouge, LA 70808 COVERAGE PROVIDED IN: Arkansas Louisiana Mississippi Missouri Nebraska Oklahoma Tennessee Texas BUSINESS HOURS Monday-Friday: 8am to 5pm CALL US: Toll Free 800.311.0997 Toll Free Fax 866.923.1871 Fraud Hotline 866.923.5223 Copyright 2021. Stonetrust Commercial Insurance Company Terms of Use / Privacy Policy / Compliance

ABOUT US POLICYHOLDER CLAIMS SAFETY OPERATIONS AGENTS NEWS/EVENTS CONTACT CLAIMS Report A Claim Claims Tips Preventing Fraud Claims Forms Your claim can be reported by phone, fax or mail. Upon receipt of your claim, we will file the appropriate documents with the proper regulatory authorities in your state. FIRST REPORT OF INJURY FORMS ARKANSAS First Report of Injury/Illness Form (PDF) LOUISIANA First Report of Injury/Illness Form (PDF) MISSISSIPPI First Report of Injury/Illness Form (PDF) MISSOURI First Report of Injury/Illness Form (PDF) NEBRASKA First Report of Injury/Illness Form (PDF) OKLAHOMA First Report of Injury/Illness Form (PDF) TEXAS First Report of Injury/Illness Form (PDF) Claims Reporting Guide (Adobe PDF) WAGE STATEMENTS ARKANSAS Wage Statement (PDF) LOUISIANA Request for Wage Info - Unit Worker (PDF) LOUISIANA Request for Wage Info - 4 Week Period (PDF) MISSISSIPPI Wage Statement (PDF) Missouri Wage Statement (PDF) NEBRASKA Wage Statement (PDF) OKLAHOMA Wage Statement (PDF) TEXAS Wage Statement (PDF) MEDICAL AUTHORIZATION Authorization for Release of Medical Records (PDF) SECOND INJURY FUND QUESTIONNAIRE FOR LOUISIANA EMPLOYERS Second Injury Fund Questionnaire (PDF) Second Injury Fund Questionnaire (Espanol) (PDF) REPORTING FRAUD Stonetrust is committed to fighting all types of workers’ compensation insurance fraud. To report suspected fraud, please call 225.201.8091 or reach us via email at fraud@stonetrustinsurance.com. NEED HELP ? CONTACT US ADDRESS 5615 Corporate Blvd Suite 800 Baton Rouge, LA 70808 COVERAGE PROVIDED IN: Arkansas Louisiana Mississippi Missouri Nebraska Oklahoma Tennessee Texas BUSINESS HOURS Monday-Friday: 8am to 5pm CALL US: Toll Free 800.311.0997 Toll Free Fax 866.923.1871 Fraud Hotline 866.923.5223 Copyright 2021. Stonetrust Commercial Insurance Company Terms of Use / Privacy Policy / Compliance