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Friendly and proactive services for workers’ compensation claims
File a Claim

Select a state:

Procedures, providers, and processes differ by state. Select the state where payroll is finalized on the map or choose from the drop-down below to see specific information.

Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Massachusetts, Maryland, Michigan, Mississippi, Minnesota, Missouri, Montana, North Carolina, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, West Virginia, Wisconsin

USL&H Claims

If you need to file a claim for a USL&H policy, please use the below forms:

USL&H Claim Kit

LS-202

LS-1

Temp Fill Form

Medical Billing

Western Integrated Care can now process your medical bills electronically with WorkCompEDI/Data Dynamics.

Take Advantage of E-Billing benefits by signing up today.

Western Integrated Care, on behalf of Benchmark Administrators Payer ID is LV191.