Report Injured Worker Fraud

Complete this form to report a person you suspect of committing fraud against the workers' compensation system.
About the person you want to report
Does the person use any other name?
Provide a statement of your concern. Is the person conducting fraudulent activities, does the person use a different address, or is the person reported incarcerated?
Known physical characteristics of the person you are reporting
Gender
Feet
Inches
Pounds
Hair color, eye color, tattoos, piercings, scars, birthmarks, mustache, etc.
Known addresses of the person you are reporting

Please select the address type above to add another address

Known phone numbers of the person you are reporting
Country

Please select the phone type above to add another phone

Known online places of the person you are reporting
Provide as many email addresses as possible, separated by commas
Facebook, Twitter, Craigslist, Skill or Chore Service Exchange, etc.
Known places we can find the person you are reporting
Work places, addresses of family or friends, after hours hangout, etc.
Do you have information about what type of vehicle they drive?
Known safety concerns when contacting the person you are reporting
Tell us how they are or could be violent. Do they have any weapons? Is there drug use?

Evidence and documentation that you want to share

Upload photos, videos, and documents.
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      Do you have additional information about the person you are reporting?
      Check all that apply:

      Your information

      I prefer to remain anonymous