Click here to go to the First Report Submission Page
This form may experience problems processing the submission if the browser is an older version. Please upgrade and resubmit.
	Microsoft Internet Explorer 6.0
	Netscape Navigator 7.0

Instructions for submission of the First Report of Occupational Injury or Disease

Step 1: Information Prompt

After reading the rest of these instructions, you can jump from this informational page to the form by clicking on the link in the upper right corner. If you wish, you may then create a bookmark or favorite in your browser to the actual form and skip this page in the future.

Step 2: Filling in the form

Input the information that you would like to submit into the fields. You can move between fields with the Tab key or your cursor. When you have completed filling out the form, click the button at the very end, marked "Submit."

The form will instantly be processed on your computer and checked for improper formatting of dates, social security numbers, and mandatory fields. If there are any errors found in the form, the submission process is halted and a warning box will appear prompting you to correct certain fields. Go to the fields indicated by their number and correct the entry. Then click the "Submit" button again. Repeat this process until all questionable entries are corrected.

If the information that is submitted passes the validation process, the First Report is sent to MMA's Claims Department for processing. If your report has been submitted without error, the page will change to a formatted layout (without submission boxes) that can be printed. A window will also pop-up that says, "Your First Report has been submitted."

Note: The current version of the First Report confirmation page will print out on two pages under most circumstances. We are sorry for the inconvenience this may cause.

• You must receive a successful submission message when finished to be sure the First Report was sent to MMA.

• In cases involving 7 or more days lost time (1 or more days for Firefighters), your MMA claims representative will contact you.

• If an employee loses time from work, subsequent to the submission of a first report, contact the MMA Claims Department immediately.

• Direct employees to appropriate medical care. If possible, direct them to a MMA preferred, occupational medicine provider. Contact your claims representative if you are not familiar with a provider in your area.

• Employees should report back after their appointment with written work restrictions.

• Be prepared to return injured workers to transitional or full duty as soon as medically appropriate.

• Your MMA claims representative is prepared to assist you. Please contact them if you have questions.

Click here to go to the First Report Submission Page

Back to MMA Home