Commonwealth of Massachusetts—http://www.mass.gov/
Department of Industrial Accidents—http://www.mass.gov/dia/
600 Washington Street, Seventh Floor
Boston, Massachusetts 02111
(800) 323-3249, (617) 727-4900; Fax: (617) 727-6477; TTY: (800) 224-6196
   Paul V. Buckley, Commissioner
   Tim McMahon, Deputy Commissioner
   William C. Tattan, Deputy Commissioner
   Martine Carroll, Senior Judge
Click here to download free fillable PDF (Portable Document Format) versions of Massachusetts workers’ compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

Massachusetts Workers’ Compensation Advisory Council—http://www.mass.gov/wcac/
600 Washington Street, Seventh Floor
Boston, Massachusetts 02111
(617) 727-4900, ext. 378; Fax: (617) 727-7122
    Edmund C. Corcoran, Jr., Chairman
    Mickey Long, Vice Chairman
    Andrew S. Burton, Executive Director

Workers’ Compensation Rating and Inspection Bureau of Massachusetts—https://www.wcribma.org/mass/
101 Arch Street
Boston, Massachusetts 02110
(617) 439-9030, Fax: (617) 439-6055
    Paul F. Meagher, President

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State of Michigan—http://www.michigan.gov/
Department of Labor & Economic Growth—http://www.michigan.gov/cis
Street Address:
611 W. Ottawa
Lansing, Michigan 48909
Mailing Address:
Post Office Box 30004
Lansing, Michigan 48909
(517) 373-1820, Fax: (517) 373-2129
    David C. Hollister, Director
Workers’ Compensation Agency—http://www.michigan.gov/wca
Street Address:
State Secondary Complex
General Office Building
7150 Harris Drive
1st Floor, B-Wing
Lansing, Michigan 48913
Mailing Address:
Post Office Box 30016
Lansing, Michigan 48909
(888) 396-5041, (313) 456-2400, Fax: (313) 456-2424
E-mail: wcinfo@michigan.gov
    Jack A. Nolish, Director, (517) 322-1106, Fax: (517) 322-6689, janolis@michigan.gov
    Bruno R. Czyrka, Deputy Director, (517) 322-1106, Fax: (517) 322-6689, bczyrk@michigan.gov
    Sue Bickel, Secretary, (517) 322-1106, Fax: (517) 322-6689, sbicke@michigan.gov
Click here to download free fillable PDF (Portable Document Format) versions of Michigan workers’ compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

Board of Magistrates—http://www.michigan.gov/wca/0,1607,7-191-26919---,00.html
Post Office Box 30016
Lansing, Michigan 48909
(517) 241-9380, Fax: (517) 241-9379, TDD in Lansing: (517) 322-5987
    Murray Gorchow, Acting Chairman, (313) 456-3657, Fax: (313) 456-3651, magorch@michigan.gov

Workers’ Compensation Appellate Commission—http://www.michigan.gov/cis/0,1607,7-154-10576_17495---,00.html
Street Address:
Ottawa Building, 2nd Floor
611 West Ottawa Street
Lansing, Michigan 48909
Mailing Address:
Post Office Box 30468
Lansing, Michigan 48909-7968
(517) 373-8020, Fax: (517) 241-1396
E-mail: wcacinfo@michigan.gov
    Martha M. Glaser, Chairperson
    James J. Kent
    Gregory A. Przybylo
    Granner S. Ries
    Rodger G. Will

Michigan Economic Development Corporation—http://medc.michigan.org/
300 North Washington Square
Lansing, Michigan 48913
(888) 522-0103, (517) 373-9808
    James C. Epolito, President and Chief Executive Officer
    Sanford “Sandy” Ring, Chief Operating Officer
    Michigan Business Guide to Workers’ Compensation—http://medc.michigan.org/services/workerscomp/
Compensation Cost Control Service
Victor Office Center, Fourth Floor
201 North Washington Square
Lansing, Michigan 48909-7968
(517) 373-9809, Fax: (517) 241-3689

Compensation Advisory Organization of Michigan (CAOM)—http://www.caom.com/
Street Address:
17197 North Laurel Park Drive, Suite 311
Livonia, Michigan 48152
Mailing Address:
Post Office Box 3337
Livonia, Michigan 48151-3337
(734) 462-9600, Fax: (734) 462-9721
    Jerry J. Stage, President and Chief Executive Officer
    Jon D. Heikkinen, Senior Vice President, CAOM Operations
    Gary L. Thompson, Vice President, Facility Operations

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State of Minnesota—http://www.mn.gov/
Department of Labor and Industry—http://www.dli.mn.gov/
443 Lafayette Road North
St. Paul, Minnesota 55155-4307
(800) DIAL-DLI (342-5354), (651) 284-5005; TTY: (651) 297-4198
    Steve Sviggum, Commissioner

Workers’ Compensation Division—http://www.dli.mn.gov/WorkComp.asp
443 Lafayette Road North
St. Paul, Minnesota 55155
(800) DIAL-DLI (342-5354) in Greater Minnesota, (651) 284-5005 in the St. Paul area, (800) 365-4584 or (218) 733-7810 in the Duluth area; Fax: (651) 284-5727
E-mail: DLI.Workcomp@state.mn.us
    Beth Hargarten, Assistant Commissioner
Click here to download free fillable PDF (Portable Document Format) versions of Minnesota workers’ compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

Workers’ Compensation Court of Appeals—http://www.workerscomp.state.mn.us/
405 Minnesota Judicial Center
25 Dr. Martin Luther King Jr. Boulevard
St. Paul, Minnesota 55155
(651) 296-6526, Fax: (651) 297-2520, TTY/TDD: (800) 627-3529
    Thomas L. Johnson, Chief Judge
    William R. Pederson, Judge
    Miriam P. Rykken, Judge
    David A. Stofferahn, Judge
    Debra A. Wilson, Judge

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State of Mississippi—http://www.state.ms.us/index.jsp 
Mississippi Workers’ Compensation Commission—http://www.mwcc.state.ms.us/
Street Address:
    1428 Lakeland Drive
    Jackson, Mississippi 39216
Mailing Address:
    Post Office Box 5300
    Jackson, Mississippi 39296-5300
(601) 987-4200, Fraud: (601) 359-4250
    Ben Barrett Smith, Chairman, (601) 987-4258,  bsmith@mwcc.state.ms.us
    Barney Schoby, Commissioner, (601) 987-4254,  bschoby@mwcc.state.ms.us
    Beverly A. Bolton, (601) 987-4256,  bbolton@mwcc.state.ms.us
    Ray C. Minor, Executive Director, (601) 987-4205,  rminor@mwcc.state.ms.us
    Jo Ann McDonald, Commission Secretary, (601) 987-4200,  jmcdonald@mwcc.state.ms.us

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State of Missouri—http://www.mo.gov/
Department of Labor and Industrial Relations—http://www.dolir.missouri.gov/index.asp
Street Address:
3315 West Truman Boulevard, Room 213
Jefferson City, Missouri 65102
Mailing Address:
Post Office Box 504
Jefferson City, Missouri 65102-0504
(573) 751-9691, Fax: (573) 751-4135
    Catherine B. Leapheart, Director, (573) 751-9691, Fax: (573) 751-4135, E-mail: Diroffice@dolir.mo.gov

• Division of Workers’ Compensation—http://www.dolir.missouri.gov/wc/
  Street Address:
  3315 West Truman Boulevard, Room 131
  Jefferson City, Missouri 65102
  Mailing Address:
  Post Office Box 58
  Jefferson City, Missouri 65102-0058
  (573) 751-4231, Fax: (573) 751-2012, Employee Hotline: (800) 775-2667, Employer Hotline: (888) 837-6069, Fraud and Noncompliance: (800)-592-6003, (573)-526-6630, Workers’ Safety Program: (573) 526-3504
  E-mail: Workerscomp@dolir.mo.gov
      Renèe Slusher, Director, (573) 751-4231, Fax: (573) 751-2012
  Click here to download free fillable PDF (Portable Document Format) versions of Missouri workers’ compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

• Labor and Industrial Relations Commission—http://www.dolir.state.mo.us/lirc/index.htm
  Street Address:
      3315 West Truman Boulevard
      Jefferson City, Missouri 65102
  Mailing Address:
      Post Office Box 599
      Jefferson City, Missouri 65102-0599
  (573) 751-2461, Fax: (573) 751-7806
      Christopher S. Kelly, Chairman
      Matthew W. O’Neill, Commissioner
      Chris Wrigley, Commissioner
      Pamela M. Hofmann, Secretary
      Victorine R. Mahon, Chief Counsel

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State of Montana—http://mt.gov/
Department of Labor and Industry—http://dli.mt.gov/
Post Office Box 1728
Helena, Montana 59624-1728
(406) 444-2840, Fax: (406) 444-1394
E-mail: dliquestions@mt.gov
    Keith Kelley, Commissioner

Employment Relations Division—http://erd.dli.mt.gov/
    Jerry Keck, Administrator

Workers’ Compensation Claims Assistance Bureau—http://erd.dli.mt.gov/wcclaims/wcchome.asp
Street Address:
1805 Prospect Avenue
Helena, Montana 59624
Mailing Address:
Post Office Box 8011
Helena, Montana 59624-8011
(406) 444-6543, Fax: (406) 444-3465, TDD: (406) 444-9696
E-mail: jakoehl@mt.gov
    Diana Ferriter, Bureau Chief, (406) 444-1574, Fax: (406) 444-4140, diferriter@mt.gov

Workers’ Compensation Regulation Bureau—http://erd.dli.mt.gov/wcregs/wcrhome.asp
Street Address:
1805 Prospect Avenue
Helena, Montana 59624
Mailing Address:
Post Office Box 8011
Helena, Montana 59624-8011
(406) 444-6541, Fax: (406) 444-3465
    Keith Messmer, Bureau Chief, (406) 444-6541, Fax: (406) 444-3465, kmessmer@mt.gov

Workers’ Compensation Court—http://wcc.dli.mt.gov/
Street Address:
    1625 11th Avenue
    Helena, Montana
Mailing Address:
    Post Office Box 537
    Helena, Montana 59624-0537
(406) 444-7794, Fax: (406) 444-7798
E-mail: pkessner@state.mt.us
    Mike McCarter, Judge

Montana State Fund—http://www.montanastatefund.com/
Street Address:
5 South Last Chance Gulch
Helena, Montana 59601
Mailing Address:
Post Office Box 4759
Helena, Montana 59604-4759
(406) 444-6500, Claim Reporting/ Customer Service: (800) 332-6102, Fraud Reporting: (888) 682-7463
    Carl Swanson, President/CEO

Self Insurers’ Guaranty Fund
Post Office Box 4133
Missoula, Montana 59806
(406) 549-8849
    George Wood, Director

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State of Nebraska—http://www.nebraska.gov/
Workers’ Compensation Court—http://www.wcc.ne.gov/
Street Address:
Lincoln, Nebraska 68509
State House, 13th Floor
Mailing Address:
Post Office Box 98908
Lincoln, Nebraska 68509-8908 
(800) 599-5155 (in Nebraska only), (402) 471-6468 (Lincoln and out of state), Fax: (402) 471-2700
    Michael K. High, Presiding Judge
    Ronald L. Brown, Judge
    Michael P. Cavel, Judge
    James K. Coe, Judge
    J. Michael Fitzgerald, Judge
    John R. Hoffert, Judge
    Laurel K. Van Norman, Judge
    Glenn W. Morton, Administrator, (402) 471-3602, Fax: (402) 471-2700, glenn.morton@wcc.ne.gov

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Nevada

State of Nevada—http://www.nv.gov/
Department of Business & Industry—http://dbi.state.nv.us/
In Northern Nevada: 
788 Fairview Avenue, Suite 100
Carson City, Nevada 89701-5491
(775) 687-4250, Fax: (775) 687-4266
E-Mail: biinfo@dbi.state.nv.us

In Southern Nevada: 
555 E. Washington Avenue, Suite 4900
Las Vegas, Nevada 89101
(702) 486-2750, Fax: (702) 486-2758
E-Mail: biinfo@dbi.state.nv.us

Division of Industrial Relations—http://dirweb.state.nv.us/
400 West King Street, Suite 400
Carson City, Nevada 89703
(775) 684-7260, Fax: (775) 687-6305
    D. Roger Bremner, Administrator, (775) 684-7260, Fax: (775) 687-6305, rbremner@dbi.state.nv.us
    John Laxalt, Assistant Administrator, (775) 684-7263, Fax: (775) 687-6305, jplaxalt@dbi.state.nv.us

Industrial Insurance Regulation Section—http://dirweb.state.nv.us/iirs.htm
400 West King Street, Suite 400
Carson City, Nevada 89703
(775) 684-7270, Fax: (775) 687-6305

Workers’ Compensation Section—http://dirweb.state.nv.us/WCS/wcs.htm
1301 North Green Valley Parkway, Suite 200
Henderson, Nevada 89074
(702) 486-9080, Fax: (702) 990-0364
E-mail: wcshelp@dbi.state.nv.us
    Charles J. Verre, Chief Administrative Officer, (702) 486-9087, cverre@dbi.state.nv.us
Northern District:
400 West King Street, Suite 400
Carson City, Nevada 89703
(775) 684-7270, Fax: (775) 687-6305
    Charlotte LaCombe, (775) 684-7278, clacombe@dbi.state.nv.us
Southern District:
1301 North Green Valley Parkway, Suite 200
Henderson, Nevada 89074
(702) 486-9080, Fax: (702) 990-0364
    Ken Webb, Manager, (702) 486-9105, kwebb@dbi.state.nv.us

Nevada Attorney for Injured Workers—http://naiw.nv.gov/
    Nancyann Leeder, Nevada Attorney for Injured Workers

2200 South Rancho Drive, Suite 230
Las Vegas, Nevada 89102
(702) 486-2830, Fax: (702) 486-2844
E-mail: naiw@naiw.nv.gov
    Gary Watson, Supervising Attorney

1000 East William Street, Suite 208
Carson City, Nevada 89701
(775) 684-7555, Fax: (775) 684-7575
E-mail: naiw@naiw.nv.gov
    Donna Sweger, Supervising Attorney

Employers Insurance Company of Nevada—http://www.employersinsco.com/
9790 Gateway Drive, Suite 100
Reno, Nevada 89521

2550 Paseo Verde Parkway
Henderson, Nevada 89074-7117
(888) 682-6671; Claim Reporting: (888) 900-1455, Fax: (888) 527-3422; Underwriting/Insurance Services: (888) 682-6671 
E-mail: info@eigwc.com
    Douglas D. Dirks, President, Chief Executive Officer
    Mary-Lou Misrahy, Executive Vice President, Chief Operating Officer
    John Donaldson, Executive Vice President, Chief Financial Officer
    Lenard Ormsby, Executive Vice President, General Counsel
    Ann Nelson, Senior Vice President, Governmental Affairs
    Rich Anderson, Senior Vice President, Insurance Operations

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State of New Hampshire—http://www.nh.gov/
Department of Labor—http://www.labor.state.nh.us/
95 Pleasant Street
Concord, New Hampshire 03301
(603) 271-3177
    George N. Copadis, Commissioner
    David M. Wihby, Deputy Commissioner
Workers’ Compensation Division—http://www.labor.state.nh.us/workers_compensation.asp
95 Pleasant Street
Concord, New Hampshire 03301
(603) 271-3174 (claims), (603) 271-2042 (coverage), (603) 271-6172 (self-insurance), (603) 271-3328 (vocational rehabilitation)
    Kathryn J. Barger, Director, (800) 272-4353, (603) 271-3176
Click here to download free fillable PDF (Portable Document Format) versions of New Hampshire workers’ compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

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State of New Jersey—http://www.state.nj.us/
Department of Labor—http://www.state.nj.us/labor/
John Fitch Plaza
Post Office Box 110
Trenton, New Jersey 08625
(609) 292-2323, Fax: (609) 633-9271
    David J. Socolow, Acting Commissioner, (609) 292-2975
Division of Workers’ Compensation—http://www.nj.gov/labor/wc/wcindex.html
Post Office Box 381
Trenton, New Jersey 08625-0381
(609) 292-2515, Fax: (609) 984-2515
E-mail: dwc@dol.state.nj.us
    Peter Calderone, Chief Judge & Director, (609) 292-2414, fax: (609) 984-2515, peter.calderone@dol.state.nj.us
    Renee Ricciardelli, Administrative Supervising Judge, (609) 292-2414, fax: (609) 984-2515, renee.ricciardelli@dol.state.nj.us
Click here to download free fillable PDF (Portable Document Format) versions of New Jersey workers’ compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

N.J. Compensation Rating and Inspection Bureau—http://www.njcrib.com/
60 Park Place
Newark, New Jersey 07102
(973) 622-6014, Fax: (973) 622-6110
    Grover E. Czech, Executive Director, (973) 622-6014, ext. 213
    Louis A. “Tony” Georges, Associate Executive Director, (973) 622-6014, ext. 215
    Roland E. Brazda III, Director, Underwriting, (973) 622-6014, ext. 214
    Frederick A. Huber, Director, Actuarial, (973) 622-6014, ext. 223
    Salvatore A. Nardone, Director, Experience Rating, (973) 622-6014, ext. 216
    John T. Skidmore, Director, Policy Review, (973) 622-6014, ext. 217

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State of New Mexico—http://www.newmexico.gov/
Workers’ Compensation Administration—http://www.workerscomp.state.nm.us/
Mailing Address:
Post Office Box 27198
Albuquerque, New Mexico 87125-7198
Street Address:
2410 Centre Avenue SE
Albuquerque, New Mexico 87125
(800) 255-7965, (505) 841-6000, Fax: (505) 841-6009
Help Line/Hot Line: (866) WORKOMP (967-5667), TTY/TDD: (505) 841-6043, E-mail: wca.hotline@state.nm.us
    Glenn R. Smith, Director, (505) 841-6007
    Abelino Montoya, Jr., Assistant Director
    Al Otero, Special Assistant to the Director
    Chris Johnston, Facilities Management
    Ida Alvarado, Financial Services
    Van Cravens, Public Information Officer, (505) 841-6004, Van.Cravens@state.nm.us
    Greg Griego, Dispute Resolution
    Sharon Gentry, Office of the General Counsel
    Christopher Marlowe, Enforcement
    Laura Feight, Deputy Director, Internal Operations Division
    Elaine Trujillo, Deputy Director, External Operations Division
    Workers’ Compensation Judges
    Gregory D. Griego, Judge, (505) 841-6023
    Terry Kramer, Judge, (505) 841-6029
    Victor S. Lopez, Judge, (505) 841-6014
    Juanita Roibal-Bradley, Judge Pro Tem, (505) 841-6029
    Helen L. Stirling, Judge, (505) 841-6841
    Advisory Council on Workers’ Compensation and Occupational Disease Disablement
    Nick Kapnison, Chairman, Business Member, (505) 872-1700
    Mike Anaya, Business Member, (505) 832-4715 or 832-4391
    Emily Kane, Labor Member, (505) 841-6000
    Mark G. Henderson, Business Member, (505) 292-8955
    Jude McMullen, Labor Member, (505) 841-6000
    Fidel A. Munoz, Labor Member, (505) 265-7933
    Glenn R. Smith, Ex-Officio Member, (505) 841-6007

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State of New York—http://www.ny.gov/
New York State Workers’ Compensation Board—http://www.wcb.state.ny.us/
20 Park Street
Albany, New York 12207
(877) 632-4996, Fax: (518) 473-1415, Fraud: (888) 363-6001
    Zachary S. Weiss, Chair
    Frances M. Libous, RN, BS, Vice Chair
    Mona A. Bargnesi, Member
    Richard A. Bell, Member
    Donna Ferrara, Member
    Candace K. Finnegan, Member
    Scott C. Firestone, Member
    Agatha Edel Groski, Member
    Karl A. Henry, Member
    Mark D. Higgins, Member
    Ellen O. Paprocki, Member
    Glenn Warren, Executive Director
    Advocate for Business, (800) 628-3331
    Edwin Ruff, Advocate for Injured Workers, (800) 580-6665, (518) 474-8182, Fax: (518) 486-7510
Click here to download free fillable PDF (Portable Document Format) versions of New York workers’ compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

New York State Insurance Fund—http://www.nysif.com/
199 Church Street
New York, New York 10007
(888) 875-5790, (212) 312-9000, Fax: (212) 385-2073
    Robert H. Hurlbut, Chairman
    David P. Wehner, Executive Director/Chief Executive Officer

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State of North Carolina—http://www.ncgov.com/
Department of Commerce—http://www.nccommerce.com/
Mailing Address:
4301 Mail Service Center
Raleigh, North Carolina 27699-4301
Street Address:
301 North Wilmington Street
Raleigh, NC 27020-0571
(919) 733-4151
E-mail: info@mail.commerce.state.nc.us
    J. Keith Crisco, Secretary

North Carolina Industrial Commission—http://www.ic.nc.gov/
Mailing Address:
4340 Mail Service Center
Raleigh, North Carolina 27699-4340
Street Address:
Dobbs Building (sixth floor)
430 North Salisbury Street
Raleigh, North Carolina 27603-5937
(919) 807-2500, Fax: (919) 715-0280, InfoSpec@ic.nc.gov, Fraud: fraudcomplaints@ic.nc.gov, Safety: safety@ic.nc.gov
    Pamela T. Young, Chair, (919) 807-2517, Pamela.Young@ic.nc.gov
    Bernadine S. Ballance, Commissioner, (919) 807-2511, Bernadine.Ballance@ic.nc.gov
    Laura Kranifeld Mavretic, Commissioner, (919) 807-2521, Laura.Mavretic@ic.nc.gov
    Danny Lee McDonald, Commissioner, (919) 807-2516, Danny.McDonald@ic.nc.gov
    Staci Meyer, Commissioner, (919) 807-2525, Staci.Meyer@ic.nc.gov
    Christopher Scott, Commissioner, (919) 807-2513, Chris.Scott@ic.nc.gov
    Dianne C. Sellers, Commissioner, (919) 807-2523, Dianne.Sellers@ic.nc.gov
    Barbara Levine, Administrator, (919) 807-2525, Barbara.Levine@ic.nc.gov

    Fraud Investigations Section: (888) 891-4895 (in North Carolina), fraudcomplaints@ic.nc.gov—http://www.ic.nc.gov/ncic/pages/fraud.htm
    Safety Education Section: (919) 807-2603, safety@ic.nc.gov—http://www.ic.nc.gov/ncic/pages/safety.htm
    Workers’ Compensation Information Specialists Section (formerly Ombudsman Section): (800) 688-8349, InfoSpec@ic.nc.gov—http://www.ic.nc.gov/ncic/pages/ombudsmn.htm
Click here to download free fillable PDF (Portable Document Format) versions of North Carolina workers’ compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

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State of North Dakota—http://www.nd.gov/
Workforce Safety & Insurance—http://www.WorkforceSafety.com/
1600 East Century Avenue, Suite One
Bismarck, North Dakota 58506-5585
(800) 777-5033, (701) 328-3800; Fax: (701) 328-3820; Fraud: (800) 243-3331; Safety and Loss Prevention: (701) 328-3886; TDD: (701) 328-3786
E-mail: WorkforceSafety@wcb.state.nd.us
    Brent J. Edison, Executive Director/CEO
Workforce Safety & Insurance Board of Directors
Post Office Box 2174
Bismarck, North Dakota 58502-2174
    David H. Ystebo, Chairman
    Robert M. Indvik, Vice Chairman
    Richard Bergstad
    Mark Gjovig
    Sindy Keller
    Cal Kolling
    Evan Mandigo
    Robert Nelson
    Denny Schneider
    Nancy A. Slotten
    Allen “Gene” Wyman, M.D.

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State of Ohio—http://ohio.gov/
Ohio Bureau of Workers’ Compensation—http://www.ohiobwc.com/
30 West Spring Street
Columbus, Ohio 43215-2256
E-mail: Feedback@bwc.state.oh.us
(800) OHIOBWC (800-644-6292); Fax: (877) 520-OHIO (6446); TTY: (800) BWC-4-TDD (800-292-4833); Authorized Consent for Release of Information: Fax: (614) 621-3376; Ombudsman: (800) 335-0996, Fax: (614) 644-1998, Ombudsperson@bwc.state.us.us
    Marsha P. Ryan, Administrator
Click here to download free fillable PDF (Portable Document Format) versions of Ohio workers’ compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

Industrial Commission of Ohio—http://www.ohioic.com/index.jsp
30 West Spring Street
Columbus, Ohio 43215-2256
(800) 521-2691, (614) 466-6136, Fax: (614) 752-8304
    William E. Thompson, Chairman
    Patrick J. Gannon, Member
    Barbara Knapic, Member

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State of Oklahoma—http://www.ok.gov/
Oklahoma Workers’ Compensation Court—http://www.owcc.state.ok.us/
Oklahoma City Location:
Denver N. Davison Court Building
1915 North Stiles Avenue
Oklahoma City, Oklahoma 73105
Tulsa Location:
440 South Houston, Suite 210
Tulsa, Oklahoma 74127
(800) 522-8210 (statewide), (405) 522-8600 (Oklahoma City) and (918) 581-2714 (Tulsa), Fax: (405) 522-8687 (administration)
    Mary A. Black, Presiding Judge
    Tom Leonard, Vice Presiding Judge
    Richard L. Blanchard, Judge
    Ellen C. Edwards, Judge
    Kenton W. Fulton, Judge
    Gene Prigmore, Judge
    Cherri Farrar, Judge
    Michael J. Harkey, Judge
    John M. McCormick, Judge
    Kent Eldridge, Judge
    Marcia Davis, Administrator, (405) 522-8776
    Mike Sykes, Supervisor, Counselors Department, (405) 522-8760 or (800) 522-8210 (statewide)

Department of Labor—http://www.okdol.state.ok.us/
4001 North Lincoln Boulevard
Oklahoma City, Oklahoma 73105-5212
(888) 269-5353, (405) 528-1500 Fax: (405) 528-5751
    Lloyd L. Fields, Commissioner, (405) 528-1500, ext. 200; Fax: (405) 528-5751; lfields@oklaosf.state.ok.us
Workers’ Compensation Enforcement Unit—http://www.okdol.state.ok.us/workcomp/index.htm
    Sharon Eischen, Director, seischen@oklaosf.state.ok.us
Worker Safety Policy Council—http://www.okdol.state.ok.us/wspc/index.htm
    Lloyd L. Fields, Chairman
    Clayton Abernathy, Member
    Scott Barger, Member
    Jim Bowien, Member
    Harry Coates, Member
    Steve Compton, Member
    Cheryl Dorrance, Member
    Debbe Leftwich, Member
    Cheryl Marcham, Member
    Chuck Mills, Member
    Gerri Mooney, Member
    Norma Noble, Member
    Robert Noll, Member
    Don Powers, Member
    Dave Koeneke, Member
    Mike Seney, Member
    Mike Wilt, Member
    Trebor Worthen, Member

CompSource Oklahoma—http://www.compsourceok.com/
Mailing Address (Oklahoma City):
Post Office Box 53505
Oklahoma City, Oklahoma 73152-3505
Street Address (Oklahoma City):
1901 North Walnut Avenue
Oklahoma City, Oklahoma 73105-3295
(800) 347-3863, (405) 232-7663; Teleclaim (to report an injury): (800) 872-7015; Claims Information: (800) 462-7966, (405) 962-3872; Fax: (405) 962-3000, Fraud Hotline: (800) 899-1847
Claims Information: claims@compsourceok.com, Fraud: fraud@compsourceok.com
Street Addresses (Tulsa Branch Office):
1305 South Denver Avenue
Tulsa, Oklahoma 74119-3040
Mailing Address (Tulsa Branch Office):
Post Office Box 50580
Tulsa, Oklahoma 74150-0580
(800) 347-3863, (918) 295-1500
    Terry McCullar, President and Chief Executive Officer, (405) 962-3334, Fax: (405) 962-3127
    Janet McFeeters, Assistant to the President, (405) 962-3262, Fax: (405) 962-3127, janet_m@compsourceok.com
    Davina Craig-Sealock, Executive Secretary, (405) 962-3294, Fax: (405) 962-3127, davina_c@compsourceok.com
    Lisa Blodgett, General Counsel, (405) 962-3811, Fax: (405) 962-3048, lisa_b@compsourceok.com
    Board of Managers:
    Tom Jaworsky, Chair
    Tony Hutchison, Vice Chair
    Ron Brown, Secretary
    Lt. Gov. Jari Askins, Member
    David Atkinson, Member
    Andy Bass, Member
    Betty Cairns, Member
    Clay Curtis, Member
    Pat Malloy, Member

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State of Oregon—http://www.oregon.gov/
Department of Consumer & Business Services—http://egov.oregon.gov/DCBS/
350 Winter Street NE
Salem, Oregon 97301-3878
(503) 378-4100, Fax: (503) 378-6444
    Cory Streisinger, Director, (503) 378-4100, DCBS.Director@state.or.us
    Greg Malkasian, Deputy Director, (503) 378-4100, Fax: (503) 378-6444, Gregory.A.Malkasian@state.or.us

Workers’ Compensation Division—http://wcd.oregon.gov/
350 Winter Street NE, Room 27
Salem, Oregon 97301-3879
(800) 452-0288 (Workers’ Compensation Infoline); (503) 947-7810, Fax: (503) 947-7514; TTY: (503) 947-7993; Fraud Hotline: (800) 422-8778 (in Oregon); Small Business Ombudsman: (503) 378-4209, Fax: (503) 373-7639; Ombudsman for Injured Workers: (800) 927-1271, (503) 378-3351, Fax: (503) 373-7639
    John L. Shilts, Administrator, (503) 947-7500, Fax: (503) 947-7514, John.L.Shilts@state.or.us
    Jerry Managhan, Deputy Administrator, (503) 947-7501, managhjr@cbs.state.or.us

Workers’ Compensation Board—http://www.cbs.state.or.us/external/wcb/index.html
2601 25th Street SE, Suite 150
Salem, Oregon 97302-1282
(503) 378-3308
    Maureen Bock, Chairman
    Frank J. Biehl, Member
    Mustafa Kasubhai, Member
    Greig Lowell, Member
    Vera Langer, Member

Workers’ Compensation Management-Labor Advisory Committee—http://www.oregon.gov/DCBS/MLAC/
Department of Consumer & Business Services
350 Winter Street, Room 200
Salem, Oregon 97301-3878
(503) 947-7867; Fax: (503) 378-6444
    Labor Representatives:
    Bob Shiprack, Co-Chair, Oregon Building Trades Council
    Lon Holston, AFSCME
    John Kirkpatrick, IUPAT District Council #5
    Mike O’Rourke, Plumbing & Steamfitters UA 290
    Brad Witt, Oregon AFL-CIO
    Management Representatives:
    J. L. Wilson, Co-Chair, NFIB/Oregon
    Ken Hector, CNF Service Company
    Diane Janzen, NorPac
    Sheri Sundstrom, Hoffman Construction Company of Oregon
    Lisa Trussell, Associated Oregon Industries
    Lou Savage, Administrator, (503) 378-4100, louis.d.savage@state.or.us

Ombudsman for Injured Workers— http://egov.oregon.gov/DCBS/OIW/index.shtml
350 Winter Street NE, Room 160
Salem, Oregon 97310
(800) 927-1271, (503) 378-3351
    Maria A. Carraher, Ombudsman for Injured Workers Maria.A.Carraher@state.or.us

Ombudsman for Small Business—http://egov.oregon.gov/DCBS/SBO/index.shtml
350 Winter Street NE
Salem, Oregon 97301-3878
(503) 378-4209, V/TTY: (503) 378-4100
    John R. Booton, Small Business Ombudsman John.R.Booton@state.or.us

SAIF Corporation—http://www.saif.com/
400 High Street SE
Salem, Oregon 97312-1000
(800) 285-8525, (503) 373-8000
    Cecil W. Tibbetts, Acting President and Chief Executive Officer
    Jon A. Egge, Chair, Board of Directors

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State of Pennsylvania—http://www.pa.gov/portal/server.pt
Department of Labor and Industry—http://www.dli.state.pa.us/
Labor & Industry Building
Room 1700
7th and Forster Streets
Harrisburg, Pennsylvania 17120
(717) 787-5279
    Sandi Vito, Acting Secretary
Bureau of Workers’ Compensation—http://www.dli.state.pa.us/landi/cwp/view.asp?a=138&q=220671
1171 South Cameron Street, Room 324
Harrisburg, Pennsylvania 17104-2501
(800) 482-2383 (inside Pennsylvania), (717) 772-4447 (local/out of state), TTY: (800) 362-4228 (for hearing and speech impaired only)
E-mail:  ra-li-bwc-helpline@state.pa.us
    John T. “Jack” Kupchinsky, Director, jkupchinsk@state.pa.us
Click here to download free fillable PDF (Portable Document Format) versions of Pennsylvania workers’ compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

State Workers’ Insurance Fund—http://www.dli.state.pa.us/landi/cwp/view.asp?a=151&q=209835
Street Address
100 Lackawanna Avenue
Scranton, Pennsylvania 18503
Mailing Address
Post Office Box 5100
Scranton, Pennsylvania 18505-5100
(570) 963-4635
E-mail: ra-li-e-mail-swif@state.pa.us
    Marisue Newman, Director

Workers’ Compensation Appeal Board--http://www.dli.state.pa.us/landi/cwp/view.asp?a=296&q=202912
1171 South Cameron Street, Room 305
Harrisburg, Pennsylvania 17104-2511
(717) 783-7838, Fax: (717) 772-0343
    Susan M. McDermott, Chairman
    Robert E. Giles, Secretary
    William R. Davis, Commissioner
    Harold V. Fergus, Jr., Commissioner
    Daniel R. Fleck, Commissioner
    Alfonso Frioni, Jr., Commissioner
    Herbert W. Hoffman, Commissioner
    Robert A. Krebs, Commissioner
    Robert T. McIntyre, Commissioner
    Gail L. O’Neal, Commissioner
    Joseph T. Rafferty, Commissioner
    Joseph P. Santone, Commissioner
    John J. Schmitt, Commissioner
    Harry Schwartz, Commissioner
    Delores Wilson, Commissioner

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State of Rhode Island—http://www.state.ri.us/
Workers’ Compensation Court—http://www.courts.state.ri.us/workers/defaultnew-workers.htm
One Dorrance Plaza
Providence, Rhode Island 02903
(401) 458-5000, Fax: (401) 222-3121
    George E. Healy, Jr., ghealy@courts.state.ri.us
    Jannette A. Bertness, Judge, jbertness@courts.state.ri.us
    Dianne M. Connor, Judge, dconnor@courts.state.ri.us
    Bruce Q. Morin, Judge, bmorin@courts.state.ri.us
    Debra L. Olsson, Judge, dolsson@courts.state.ri.us
    Hugo L. Ricci, Jr., Judge, hricci@courts.state.ri.us
    John Rotondi, Jr., Judge, jrotondi@courts.state.ri.us
    George T. Salem, Jr., Judge, gsalem@courts.state.ri.us
    Edward P. Sowa, Jr., Judge, esowa@courts.state.ri.us
    Dennis I. Revens, Administrator, drevens@courts.state.ri.us
    Kenneth D. Haupt, Deputy Administrator, khaupt@courts.state.ri.us

Medical Advisory Board—http://www.courts.ri.gov/workers/medical/medical-advisory.htm
One Dorrance Plaza
Providence, Rhode Island 02903
(401) 458-3460
    Vincent J. Yakavonis, MD, Chair
    Maureen Aveno, Administrator, MAveno@courts.state.ri.us

Workers’ Compensation Advisory Council
194 Smith Street
Providence, Rhode Island 02908
(401) 751-7100
    George Nee, Chairperson

Department of Labor and Training—http://www.dlt.ri.gov/
1511 Pontiac Avenue
Cranston, Rhode Island 02920-4407
(401) 462-8000
    Adelita S. Orefice, Director, AOrefice@DLT.state.ri.us
Workers’ Compensation Division—http://www.dlt.ri.gov/wc/
Street Address:
1511 Pontiac Avenue, Building 69, Second Floor
Cranston, Rhode Island 02920-0942
Mailing Address:
Post Office Box 20190
Cranston, Rhode Island 02920-0190
(401) 462-8100, Fax: (401) 462-8105, TDD: (401) 462-8006
    E. Jean Severance, Associate Director, (401) 462-8081, JSeverance@DLT.state.ri.us
    Matthew P. Carey, III, Assistant Director, (401) 462-8127, MCarey@DLT.state.ri.us
Click here to download free fillable PDF (Portable Document Format) versions of Rhode Island workers’ compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

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State of South Carolina—http://www.sc.gov/
Workers’ Compensation Commission—http://www.wcc.sc.gov/
Street Address:
1612 Marion Street
Columbia, South Carolina 29201
Mailing Address:
Post Office Box 1715
Columbia, South Carolina 29202-1715
(803) 737-5700, Fax: (803) 737-5768
    Andrea C. Roche, Chairman, (803) 737-5700, Fax: (803) 737-5764
    Susan S. Barden, Commissioner, (803) 737-5700, Fax: (803) 737-5764
    T. Scott Beck, Commissioner, (803) 737-5700, Fax: (803) 737-5764
    David W. Huffstetler, Commissioner, (803) 737-5700, Fax: (803) 737-5764
    G. Bryan Lyndon, Commissioner, (803) 737-5700, Fax: (803) 737-5764
    Avery B. Wilkerson, Jr., Commissioner, (803) 737-5700, Fax: (803) 737-5764
    Derrick L. Williams, Commissioner, (803) 737-5700, Fax: (803) 737-5764
    Gary R. Thibault, Executive Director, (803) 737-5744, Fax: (803) 737-5764, gthibault@wcc.sc.gov
Click here to download free fillable PDF (Portable Document Format) versions of South Carolina workers’ compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

South Carolina State Accident Fund—http://www.saf.sc.gov/ 
Street Address:
800 Dutch Square Boulevard
Columbia, South Carolina 29221
Mailing Address:
Post Office Box 102100
Columbia, South Carolina 29221-5000
(800) 521-6576, (803) 896-5800
    Irvin D. “Pete” Parker, Director, pparker@scsn.net

South Carolina Second Injury Fund—http://www.scsif.sc.gov/
220 Executive Center Drive
Winthrop Building, Suite 119
Columbia, South Carolina 29210
(803) 798-2722, Fax: (803) 798-5290
    William E. Gunn, Director
    Michael T. Harris, Deputy Director
    Debbie Manning, Administrative Manager
    Pete Calamas, Director of Claims
    Ann P. Corley, Director of Recoveries
    Latonya D. Edwards, General Counsel
    South Carolina Workers’ Compensation Uninsured Employers’ Fund
    220 Executive Center Drive
    Winthrop Building, Suite 119
    Columbia, South Carolina 29210
    (803) 798-2722, Fax: (803) 798-5290

South Carolina Self-Insurers Association—http://www.scselfinsurers.com/
215 Holly Ridge Lane
West Columbia, SC 29169
(803) 794-2080, Fax: (803) 939-8366
    Mobashir “Moby” Salahuddin, Executive Director, msalahuddin@sc.rr.com
Board of Directors
    Hugh McAngus, President
    David Hill Keller, Vice President
    David Benenhaley, Secretary
    Brian J. Teusink, CPA, CCM, AIAF, Treasurer
    Sam Painter, Legal Counsel
    Janeen Cantillion, Board Member
    Jim Connor, Board Member
    Ted Contos, Board Member
    Earl Ellis, Board Member
    Joseph H. Hutchinson, Board Member
    Harvey Mathias, Board Member
    John Mellette, Board Member
    Jeffrey Ranew, Board Member
    Douglas Schueler, Board Member
    M. Clifton Scott, Board Member
    Kevin Thibault, Board Member
    Tony Timmerman, Board Member

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State of South Dakota—http://www.sd.gov/
Department of Labor—http://dol.sd.gov/
    Pamela S. Roberts, Secretary of Labor
Workers’ Compensation Program—http://dol.sd.gov/workerscomp/default.aspx
Kneip Building
700 Governors Drive
Pierre, South Dakota 57501-2291
E-mail: labor@dol-pr.state.sd.us
(605) 773-3681, Fax: (605) 773-4211
    James Marsh, Director
Workers’ Compensation Advisory Council—http://dol.sd.gov/workerscomp/advisorycouncil.aspx
    Dennis Daugaard, Chair

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State of Tennessee—http://www.tennessee.gov/
Department of Labor and Workforce Development—http://www.tennessee.gov/labor-wfd/
Workers’ Compensation Division—http://www.state.tn.us/labor-wfd/wcomp.html
710 James Robertson Parkway
Gateway Plaza, Second Floor
Nashville, Tennessee 37243-0665
(800) 332-2667 (within Tennessee), (615) 532-4812, Fax: (615) 532-1468
    Sue Ann Head, Administrator
    Blaine Sprouse, Assistant Administrator
Click here to download free fillable PDF (Portable Document Format) versions of Tennessee workers’ compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

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State of Texas—http://www.state.tx.us/
Department of Insurance—http://www.tdi.state.tx.us/
Street Address
333 Guadalupe
Austin, Texas 78701
Mailing Address
Post Office Box 149104
Austin, Texas 78714-9104
(800) 578-4677, (512) 463-6169
    Mike Geeslin, Commissioner, (512) 463-6464, Fax: (512) 475-2005
Division of Workers’ Compensation—http://www.tdi.state.tx.us/wc/indexwc.html
7551 Metro Center Drive, Suite 100
Austin, Texas 78744-1609
Main number: (512) 804-4000; Commissioner’s office: (512) 804-4435, fax: (512) 804-4401; Field Offices: (800) 252-7031 (local customer service); Fraud Hotline: (888) 327-8818 or (512) 804-4703; Safety Violations Hotline: (800) 452-9595; Technical Help Desk (TXCOMP, EDI) (888) 4-TXCOMP
E-Mail: WorkersCompCustomerServices@tdi.state.tx.us  
    Rod Bordelon, Commissioner of Workers’ Compensation
Click here to download free fillable PDF (Portable Document Format) versions of Texas workers’ compensation forms: http://www.tdi.state.tx.us/forms/form20all.html.

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State of Utah—http://www.utah.gov/ 
Labor Commission—http://www.laborcommission.utah.gov/
    Sherrie M. Hayashi, Commissioner
Division of Industrial Accidents—http://www.laborcommission.utah.gov/IndustrialAccidents/index.html
Mailing Address:
Post Office Box 146610
Salt Lake City, Utah 84114-6610
Street Address:
160 East 300 South, 3rd Floor
Salt Lake City, Utah 84111
(800) 530-5090 (in state only), (801) 530-6800, Fax: (801) 530-6804, TDD:  (801) 530-7685
iaccd@utah.gov
    R. Lee Ellertson, Chairman
    Thomas R. Carlson, Commissioner
    Colleen S. Colton, Commissioner
    Larry D. Bunkall, Director, (801) 530-6988, Fax: (801) 530-6804, lbunkall@utah.gov

Workers’ Compensation Fund—https://www.wcfgroup.com/wcfWebsite/homePage.do
Salt Lake City Office
392 East 6400 South
Murray, Utah 84107
(800) 446-2667
    Ray Pickup, President and Chief Executive Officer, (801) 288-8000
Board of Directors
    Robert D. Myrick, Chair
    Judd A. Turner , Vice Chair
    Dallas H. Bradford
    Roger Livingston
    Ruth Lybbert
    Robert B. Murray
    Lane A. Summerhays
 

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State of Vermont—http://vermont.gov/
Department of Labor—http://labor.vermont.gov/
Street Address
5 Green Mountain Drive
Montpelier, Vermont 05601-0488
Mailing Address
Post Office Box 488
Montpelier, Vermont 05601-0488
(802) 828-4000, Fax: (802) 828-4022
    Patricia A. McDonald, Commissioner, (802) 828-4000, pmcdonald@labor.state.vt.us

Workers’ Compensation Division
FAQ for Injured Workers—http://labor.vermont.gov/Workers/Injured/tabid/110/Default.aspx
FAQ for Businesses—http://159.105.83.167/WorkersCompensation/tabid/114/default.aspx
National Life Building
Drawer 20
Montpelier, Vermont 05620-3401
(802) 828-2286, Fax: (802) 828-2195
    Kristina Bielenberg, Supervisor, (802) 828-2286, kristina.bielenberg@labor.state.vt.us
Click here to download free fillable PDF (Portable Document Format) versions of Vermont workers’ compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

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Commonwealth of Virginia—http://www.virginia.gov/
Virginia Workers’ Compensation Commission—http://www.vwc.state.va.us
1000 DMV Drive
Richmond, Virginia 23220
(877) 664-2566, Fax: (804) 367-9740, TDD: (804) 367-8600
E-mail: Questions@vwc.state.va.us
    Lawrence D. Tarr, Chairman, (804) 367-8666
    Virginia R. Diamond, Commissioner, (804) 367-8657
    William L. Dudley, Jr., Commissioner, (804) 367-8659
    James J. Szablewicz, Chief Deputy Commissioner, (804) 367-8664
    Kim Harris, Manager, Human Resources Department, (804) 367-8637
    Edward P. Rice, Comptroller, (804) 367-0580
    R. Temple Mayo, Director of Claims/Deputy Commissioner, (804) 367-8625
    Eileen Mundok, Chief Information Officer, (877) 664-2566
Click here to download free fillable PDF (Portable Document Format) versions of Virginia workers’ compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

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State of Washington—http://access.wa.gov/
Department of Labor and Industries—http://www.lni.wa.gov/
Labor and Industries Building
Post Office Box 44001
Olympia, Washington 98504-4001
(800) 547-8367, (360) 902-4200, Fax: (360) 902-4202
    Judy Schurke, Director
Workers’ Comp Claims—http://www.lni.wa.gov/ClaimsIns/Claims/default.asp

Board of Industrial Insurance Appeals—http://www.biia.wa.gov/
Street Address:
2430 Chandler Court, SW
Olympia, Washington 98504-2401
Mailing Address:
Post Office Box 42401
Olympia, Washington 98504-2401
(800) 442-0447, (360) 753-9646, Fax: (360) 586-5611
    Thomas E. Egan, Chairman and Public Member
    Frank E. Fennerty, Jr., Labor Member
    Calhoun Dickinson, Employer Member
Click here to download free fillable PDF (Portable Document Format) versions of Washington workers’ compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

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West Virginia—http://www.wv.gov/
Insurance Commission—http://www.wvinsurance.gov/
    Jane L. Cline, Commissioner

BrickStreet Mutual Insurance Company—http://www.brickstreet.com/
(formerly West Virginia Workers’ Compensation Commission)
Mailing Address:
Post Office Box 3824
Charleston, West Virginia 25338-3824
Street Address:
400 Quarrier Street
Charleston, West Virginia 25301
Administrative Services: (888) 4-WV-COMP and (304) 926-3400, Fax: (304) 926-5372; Claims: ClaimsInquiries@brickstreet.com; Fraud: reportfraud@brickstreet.com; Insurance: (866) 45BRICK (452-7425) and (304) 941-1000, Fax: (304) 304-941-1151; Providers: ProviderInquiries@brickstreet.com; Safety Services: SafetyServicesInquiries@brickstreet.com
    Gregory A. Burton, President and Chief Executive Officer, (304) 926-5060, greg.burton@brickstreet.com
    Phillip A. Lynch, Senior Vice President
    R. Philip Shimer, Senior Vice President, Strategic Business Group
    T.J. Obrokta, Jr., Senior Vice President and General Counsel
    J. Christopher Howat, CPA, Senior Vice President, Treasurer and Chief Financial Officer
    Harry Mahler, Senior Vice President, Insurance Operations
Board of Directors
    Gregory A. Burton
    Thomas V. Flaherty
    Phillip A. Lynch
    David Rader
    Stephen Roberts
    H. Skip Tarasuk, Jr.
    Steven F. White

Workers’ Compensation Office of Judges—http://www.wvinsurance.gov/ooj/
Mailing Address:
Post Office Box 2233
Charleston West Virginia 25328-2233
Street Address:
One Players Club Drive
Charleston West Virginia 25311-1638
(304) 558-1686, Fax: (304) 558-1021
    Timothy G. Leach, Chief Administrative Law Judge

Workers’ Compensation Board of Review—http://www.wvinsurance.gov/boardofreview/index.htm
Mailing Address:
Post Office Box 2628
Charleston, West Virginia 25329-2628
Street Address:
104 Dee Drive
Charleston, West Virginia 25301
(304) 558-5230, Fax: (304) 558-1322
    Robert G. Wolpert, Chair
    Rita Hedrick-Helmick, Member
    W. Jack Stevens, Member

Workers’ Compensation Industrial Council—http://www.wvinsurance.gov/wc/industrialcouncil/index.htm
    Charles Bayless, Chairman
    Bill Dean, Vice Chairman
    Jane L. Cline, Insurance Commissioner
    Robert S. Kiss, Member
    Dan Marshall, Member
    Sarah Minear, Member
    Brooks McCabe, Member
    Walter Pellish, Member
    Rick Slater, Member

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State of Wisconsin—http://www.wisconsin.gov/state/home
Department of Workforce Development—http://www.dwd.state.wi.us/
Workers’ Compensation Division—http://www.dwd.state.wi.us/wc/default.htm
Mailing Address:
Post Office Box 7901
Madison, Wisconsin 53707-7901
Street Address:
Room C100
201 East Washington Avenue
Madison, Wisconsin 53703
(608) 266-1340; Fax: (608) 267-0394; Fraud (608) 261-8486
    Frances Huntley-Cooper, Administrator, (608) 266-6841, frances.huntley-cooper@dwd.state.wi.us
    John Conway, Deputy Administrator, (608) 266-0337, conwajo@dwd.state.wi.us
    Jean Culbert, Administrative Support, (608) 266-6898, culbeje@dwd.state.wi.us
Click here to download free fillable PDF (Portable Document Format) versions of Wisconsin workers’ compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

Workers’ Compensation Advisory Council—http://www.dwd.state.wi.us/wc/councils/wcac/default.htm
(608) 266-6841
    Frances Huntley-Cooper, Chairman

Wisconsin Compensation Rating Bureau—https://www.wcrb.org/WCRB/wcrbhome.htm
Mailing Address:
Post Office Box 3080
Milwaukee, WI 53201-3080
Street Address:
20700 Swenson Drive, Suite 100
Waukesha, Wisconsin 53186
(262) 796-4540, Fax: (262) 796-4400
    Ralph M. Herrmann, President, herrmra@dwd.state.wi.us

Wisconsin Labor and Industry Review Commission—http://www.dwd.state.wi.us/lirc/
Mailing Address:
Post Office Box 8126
Madison, Wisconsin 53708-8126
Street Address:
Wisconsin Public Broadcasting Building
3319 West Beltline Highway
Madison, Wisconsin
(608) 266-9850 Fax: (608) 267-4409
    E-mail: dwdlirc@dwd.state.wi.us
    David B. Falstad, Chairman
    Laurie R. McCallum, Commissioner
    James A. Rutkowski, Commissioner
    James L. Pflasterer, General Counsel

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State of Wyoming—http://wyoming.gov/
Department of Employment—http://wydoe.state.wy.us/
Cheyenne Business Center
1510 East Pershing Boulevard
Cheyenne, Wyoming 82002
(307) 777-7672, Fax: (307) 777-5805
    Gary W. Child, Director, (307) 777-5960, GCHILD@STATE.WY.US
    Charles Rando, Administrator, (307) 777-6370, CRANDO@state.wy.us

Employment Tax Division—http://wydoe.state.wy.us/doe.asp?ID=10
Post Office Box 2760
Casper, Wyoming 82602-2760
(307) 235-3201 (Casper) or (307) 777-7471 (Cheyenne)
    Wendy Tyson, Administrator, (307) 777-6763, wtyson@state.wy.us

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Other U.S. Areas

American Samoa—http://www.government.as/
Workmen’s Compensation Commission
Office of the Governor
Pago Pago, American Samoa 96799
(684) 633-4116
    Moaali’itele Tu’ufuli, Commissioner
    Tasi Mauga, Administrator

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Government of Guam—http://www.guam.gov/
Department of Labor/Agency for Human Resources Development—http://www.dol.guam.gov/
    Maria S. Connelley, Director of Labor
Workers’ Compensation Commission—http://www.guamdol.net/content/view/27/83/
Street Address:
414 West Soledad Avenue
GCIC Building
Hagatna, Guam 96910
Mailing Address:
Post Office Box 9970
Tamuning, Guam 96931-9970
(671) 475-7033 and (671) 475-7034, Fax: (671) 475-7026
    Maria S. Connelley, Commissioner
    Mary Guerrero, Commissioner
    Elizabeth Hanzsek, Commissioner
    Dr. Gregory J. Miller, Commissioner
    Franklin Taitague, Commissioner
    Joannalynn Fullerton, Acting Administrator, fullertonjoannalynn@yahoo.com

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Navajo Nation—http://www.navajo.org/
Workers’ Compensation Program
Post Office Box 2489
Window Rock, Arizona 86515
(928) 871-6389, Fax: (928) 871-6087
    Charlene B. Chapman, Director, cchapman@nnisd.com or charchapman@navajo.org

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Northern Mariana Islands

Commonwealth of the Northern Mariana Islands—http://www.gov.mp/
Caller Box 10,007
Saipan, MP 96950
USA
(670) 664-2200

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Puerto Rico—http://www.gobierno.pr/
Comisión Industrial de Puerto Rico—http://www.cipr.gobierno.pr/
Post Office Box 364466
San Juan, Puerto Rico 00936-4466
(787) 781-0545, Fax: (787) 783-5610
E-mail: contacto@cipr.gobierno.pr
    Lucy Navarro Rosado, President
    Nilda Diaz Olazagasti, Commissioner
    Carmen M. Llull Vera, Commissioner

State Insurance Fund
Post Office Box 5028
San Juan, Puerto Rico 00936
    Zoimee Alvarez Rubio, Administrator

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Virgin Islands—http://www.usvi.org/
Department of Labor—http://www.vidol.gov/
St. Croix (Main Office)
302 King Street
St. Croix, Virgin Islands 00840-4612
(340) 773-1994, Fax: (340) 772-3365
St. Thomas (Main Office)
Post Office Box 302608
St. Thomas, Virgin Islands 00803-2608
(340) 776-3700, Fax: (340) 774-5908
    Cecil R. Benjamin, Commissioner
Workers’ Compensation Administration—http://www.vidol.gov/Units/Workers_Compensation/Workers_Comp.htm
3012 Vitraco Mall, Golden Rock
Christiansted
St. Croix, Virgin Islands 00820-4666
(809) 692-9390, Fax: (809) 773-4338
    Idona Byron, Acting Director

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Canada

Government of Canada—http://canada.gc.ca/
Labour Program
Human Resources Development Canada—http://labour-travail.hrdc-drhc.gc.ca/
Human Resources Development Canada
11 Prince of Wales Drive
Ottawa, Ontario K2C 3T2
(800) 463-2493 (in Canada), (416) 954-5900 (Metro Toronto Area), (519) 645-4424 (London Area)

Alberta

Government of Alberta—http://www.gov.ab.ca/index2.html
Department of Labour—http://www.gov.ab.ca/~lab/
9940 - 106 Street
Edmonton, Alberta T5K 2N2
(403) 427-8848, (403) 297-2222 (Calgary)
Workers’ Compensation Board-Alberta—http://www.wcb.ab.ca/
Box 2415, 9912 - 107 Street
Edmonton, Alberta~ T5J 2S5
(403) 498-4000, (403) 498-4950 (Government Relations Office-Edmonton), Fax: (403) 422-2889 TTY: (403) 422-2716
E-mail: geninfo.wcb.ab@ibm.net
    Rick LeLacheur, Chairman of the Board of Directors

British Columbia

Government of British Columbia—http://www.gov.bc.ca/
Workers’ Compensation Board of British Columbia—http://www.worksafebc.com/
6951 Westminster Highway
Post Office Box 5350 STN Terminal
Richmond, British Columbia V6B 5L5
(800) 661-2112 (in British Columbia only), (604) 273-2266, (604) 273-7711 (after hours safety and health emergency reporting) Fax: (604) 276-3151

Manitoba

Government of Manitoba—http://www.gov.mb.ca/
Department of Labour
Workplace Safety and Health Division—http://www.gov.mb.ca/labour/safety/index.html
200 - 401 York Avenue
Winnipeg, Manitoba R3C 0P8
(800) 282-8069, (204) 945-3446 Fax: (204) 945-4556
Workers’ Compensation Board of Manitoba—http://www.wcb.mb.ca/
E-mail: wcb@wcb.mb.ca

New Brunswick

Government of New Brunswick—http://www.gov.nb.ca/
New Brunswick Workplace Health, Safety and Compensation Commission—http://www.gov.nb.ca/whscc/index.htm
1 Portland Street
Post Office Box 160
Saint John, New Brunswick E2L 3X9
(800) 222-9775 (in New Brunswick only), (506) 632-2200 Fax: (506) 738-4229

Newfoundland and Labrador

Government of Newfoundland—http://www.gov.nf.ca/
Department of Environment and Labour—http://www.gov.nf.ca/env
Occupational Health and Safety Division
Confederation Building, 4th Floor, West Block
Post Office Box 8700
St John’s, Newfoundland A1B 4J6
(800) 563-5471 (in Newfoundland only), (709) 729-1932 Fax: (709) 729-6639
Workers’ Compensation Commission of Newfoundland and Labrador—http://www.wcb.nf.ca/

Northwest Territories

Government of the Northwest Territories —http://www.gov.nt.ca/
Northwest Territories Workers’ Compensation Board
Post Office Box 8888
Yellowknife, Northwest Territories X1A 2R3
(800) 661-0792 (in North America), (867) 920-3888 Fax: (867) 873-4596

Nova Scotia

Government of Nova Scotia—http://www.gov.ns.ca/
Occupational Health & Safety Division
Department of Labour
5151 Terminal Road, 6th floor
Post Office Box 697
Halifax, Nova Scotia B3J 2T8
(800) 9-LABOUR or (800) 952-2687 (in Nova Scotia only), (902) 424-5400 Fax: (902) 424-3239
Workers’ Compensation Board of Nova Scotia—http://www.wcb.ns.ca/

Ontario

Government of Ontario—http://www.gov.on.ca/
Occupational Health & Safety Branch—http://www.gov.on.ca/LAB/ohs/ohse.htm
Ministry of Labour —http://www.gov.on.ca/LAB/
400 University Avenue, 8th Floor
Toronto, Ontario M7A 1T7
(800) 268-8013 (in Ontario only), (416) 326-7770 Fax: (416) 326-7761
Workplace Safety & Insurance Board (formerly Workers’ Compensation Board)—http://www.wcb.on.ca/wcb/wcb.nsf/public/homepage (new site available soon: http://www.wsib.on.ca)
200 Front Street West
Toronto, Ontario
800) 387-5540, (416) 344-1000 Fax: (416) 344-4684 TTY: (800) 387-0050
E-mail: wsibcomm@wsib.on.ca
Workplace Safety and Insurance Appeals Tribunal—http://www.wcat.on.ca/engindex.htm
505 University Avenue, 7th Floor
Toronto, Ontario M5G 1X4
(416) 598-4638 Fax: (416) 326-5164
    Ian Strachan, Chairman
Occupational Health and Safety Branch
Ministry of Labour—http://www.gov.on.ca/LAB/ohs/
400 University Avenue, 8th Floor
Toronto, Ontario M7A 1T7
(800) 268-8013 (in Ontario only), (416) 326-7770 Fax: (416) 326-7761

Prince Edward Island

Government of Prince Edward Island—http://www.gov.pe.ca/
Occupational Health and Safety Division
Workers’ Compensation Commission
P.O. Box 757
Charlottetown, Prince Edward Island C1A 7L7
(800) 237-5049 (in Prince Edward Island only), (902) 368-5680 Fax: (902) 368-5696

Québec

Province of Québec—http://www.gouv.qc.ca/
Commission de la santé et de la sécurité du travail du Québec—http://www.csst.qc.ca/
(Occupational Health and Safety Commission)
C P 6056, Succursale Centre-ville
Montréal, Québec H3C 4E1
(800) 667-7585 (in Québec only), (514) 864-9362 Fax: (514) 864-9214

Saskatchewan

Government of Saskatchewan—http://www.gov.sk.ca/
Department of Labour—http://www.gov.sk.ca/govt/labour/
Occupational Health and Safety Division
1870 Albert Street
Regina, Saskatchewan S4P 3V7
(800) 567-7233, (306) 787-4496 Fax: (306) 787-2208 ~ Saskatoon Office: (306) 933-5042; 1-800-667-5051 FAX: (306) 933-7339

Yukon Territory

Government of Yukon—http://www.gov.yk.ca/
Workers’ Compensation, Health and Safety Board
Occupational Health and Safety Branch
401 Strickland Street
Whitehorse, Yukon Territory Y1A 5N8
(800) 661-0443, (867) 667-5450 Fax: (867) 393-6279