Report Workers' Compensation Fraud

Please fill in the form below with as much information as possible that relates to the suspected workers’ compensation fraud.

If you wish to remain anonymous, you may. However, it is found that additional contact is usually necessary to effectively investigate fraud.
Please note that your identity will be kept confidential.

Once you complete the form, click the Save button to send the information to the Beacon Special Investigation Unit (SIU) or the Premium Fraud Investigator.

Thank you for your assistance in fighting workers’ compensation fraud!

Who are you reporting? *

Other Name(s) / Aliases

Address of Person or Company Being Reported

Employer of Person Being Reported

Employer's Address

Date of Birth or Approximate Age of Person

Physical Description of Person

Occupation

Description of Residence or Place of Business

Vehicle Description / Plate Number (if applicable)

Approximate Date(s) of Fraud

Describe the Fraud

Do you want to remain anonymous?

If you provide your contact information, it will help Beacon effectively investigate the fraud if additional detail is needed. It will not be shared with the person or company that is being reported.

Your Name (Optional)

Your Contact Information

Attachments