Serving Connecticut's Healthcare Employers For Over 25 Years

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Members

• Introduction
• Benefits to Members
• Education Calendar
• Managed Care
  • Medical Care Plan
  • Nurse Case Management
  • Medical Care Plan Application
  • Rights and Responsibilities
• Claims Administration
  • How to Report Claims
  • Report a Claim
  • Run Report
  • Fraud Policy
    • Fraud Poster (PDF)
  • Claim Forms
  • Sample Policies (PDF)
  • First Fill Form (DOC)
• Loss Control
  • How To Contact Us
  • Loss Control Services
  • Focus Groups
  • Trust Supported Products
• Protection for Members
• Online Confidentiality Agreement

Report a Claim

To report a claim, please click here for the First report of injury form. You then have 2 options:

1. Complete the form on-line, print and fax to 203-294-0082 or
2. Save the blank form to your desktop and use as needed. Once completed, you can either fax to the number above or email it to us at 1streport@wctrust.com .

If you have any questions, contact 1-800-506-2655.

For electronic filers: click here

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