Report a Work-related Injury or Illness
FIRST NOTICE OF LOSS (FNOL)
Supervisor Instructions: Following is a link to a quick reference on reporting work-related injuries and illnesses. Click to download Supervisor Instructions for Workers’ Compensation Claims.
How to Report a First Notice of Loss (FNOL)
You may report a Workers’ Compensation claim two ways:
Option 1. On-line at CareMC. The supervisor is able to complete the first report via the website. Click to access CareMC. A user ID and password are required for access. To request a user ID and password, please contact Pearl Monroe at Pmonroe@mcinnovations.com.
Watch the video below, or watch it here on YouTube.
Click to learn how to change your CareMC password.
Download the Create a New Claim Intake Form for more information.
View the Location Code Directory.
Option 2. By phone 24/7 at 888 606-2562. The phone will be automatically answered “Montgomery County Self Insurance Program, first report of injury”. A telephonic first report representative will receive your call and prompt you through the questions necessary to complete the report. The representative will complete the FNOL, electronically forward a copy to the MCSIP claim office and return a copy to the reporting individual, if requested.
Click to download How to Report Employee Work-Related Injuries/Illnesses. The “How To” document is a tool to assist you in organizing information prior to making your call. The following items are a few of the key questions asked:
- Agency name, address and location code (if known)
- Agency name, address and location code (if known) – View the Location Code Directory
- Injured employee’s full name, date of birth, and social security #
- Date the accident occurred
- Location of the accident and any witnesses
- Your description of the accident, please start with “Employee states” (remember, this is the employer’s report of the accident)
- Name and address of all medical providers
- Date of Hire
- Is the injured employee a member of a Union, if so, which one
- Is the Injured Employee opting to treat with a Workers’ Compensation Network Physician and within the Manage Care Program
Questions? Call MCI at (703) 817-0407.
If you need a supply of preprinted cards, please click here and advise how many and the correct name and address to send the cards.