Report Employer Premium Fraud
in Washington State

Do you wish to file a complaint with L&I about an employer you believe is taking advantage of the Washington State workers' compensation system? Let us know by completing this form. We take action against fraud because it increases costs for everyone. Provide as much information as you can. We will need it to pursue your complaint.
Information About Employer You Are Reporting
Business Address
Format: XXX-XXX-XXXX

Principal Owner Name

(9-digits, format: 123456789 or A12345678)
What fraud are you reporting?
Worker Information
Do you have information about workers?
(Examples: names, contact phone numbers, SSN, length of employment, email addresses, web sites, license plate numbers, etc.)
General Contractor Information
Do you have information about who they work for?
(Examples: general contractor name, prime contractor names, phone numbers, etc.)

Other Business Locations
Do you have information about any other business locations or site addresses?
(Examples: addresses, phone numbers, other contact names, directions, landmarks, etc.)

Work Activities/Other Information
Can you describe the business work activities?
Do you have other information to share?
(Examples: Your preferred method of contact, alternative contact information, other observations, etc.)
When did you observe fraud?

Example: 10/22/2018

Do you know of any hazards that we should be aware of?
(Examples: Hazardous materials, safety comments for auditor, unsafe workplace, etc.)

Electronic/Non-electronic Documents
Do you have documents available?
Your Information
I prefer to remain anonymous
Upload