HMS Insurance Associates, Inc.
has published the form ACORD 4 Workers Compensation - First Report of Injury or Illness - Replaced 09-2016
Please enter your name and click on one of the 'Edit' buttons below.
You will be directed to a form that you can fill out. When you are done filling out the form, click 'Submit' button. The form will only be submitted to HMS Insurance Associates, Inc.
Please note that if you choose to edit as PDF, you must fill out and submit the form in one session. If you wish to save and continue later, please choose another editing method.
Please fill in: