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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).

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

 
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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?


Your Name (Optional)


Your Contact Information


Attachments