Harris Madden & Powell

If you are a commercial insurance client, listed below are links to forms that may be used to file a claim. Please complete the form and fax to our office:

Auto Loss Notice

Property Loss Notice

General Liability Loss Notice

Workers' Compensation Reporting Forms

To secure First Report of Injury or Accident Reports from a specific state, please select the state below and click "GO". The link will take you to the selected state workers' compensation website where you can download or request forms.

Please remember that the First Report of Injury Form (Form C-20 for TN) must be completed and sent to the insurance company within the first 24 hours of the employer's knowledge of an injury/accident. Also, note that it is mandatory in the state of Tennessee that the employer must offer the injured employee a proper panel of physicians to choose from for treatment. This documentation is accomplished by the use of the Employees Choice of Physician Form (Form C-42 for TN.)

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