Claim Notification Process

Claim Forms


Claims Notification Process Claim Submission Please follow the process below for submitting a claim. 1) Send claim notice to claimspl@cisoregon.org for auto/liability/property claims and claimswc@cisoregon.org for workers compensation claims with attached documents. OR 2) Complete the form on this page (in the Claim Forms box to the right) that relates to your claim (Workers’ Compensation, Automobile Crash, General Liability, property Claim) 3) If the form is not submitted electronically, please fax to 503-763-3901 Emergency Claim Notification Process Please utilize the following procedures when reporting serious incidents* or fatalities. * Serious incidents would include accidents involving injuries requiring admittance to a hospital, police incidents involving use of firearms, public allegations of sexual misconduct involving public officials, or other "high profile" incidents involving potential civil liability. Contact local emergency response personnel to handle immediate threats to life or property. Secure the scene. Follow your Emergency Policy/Procedure for internal response, reporting notification. Notify CIS Claims at 1-800-922-2684 and ask to be directed to Jim McWilliams (Claims Manager). If you are calling after hours and this is a true emergency, call the emergency claims number, 503-763-3897, and your call will be forwarded to the on-call claims examiner. Contact your Employee Assistance Program (EAP) for counseling and critical incident debriefing as needed. Conduct an internal investigation, document facts and submit the appropriate claim form to CIS Claims. Workers’ Compensation claim forms are available online. If news media are requesting comment, be sure to follow your entity’s policy regarding media contact and public information. If you need assistance in developing such a policy, please contact CIS. Please note to call OR-OSHA at 1-800-922-2689 if a fatality or serious disabling injury requiring hospitalization has occurred. Fatalities must be reported within 8 hours and in-patient hospitalization of an employee within 24 hours. An incident report may be used if the injured worker is not planning to seek medical treatment. The 801 Claim Form must be completed when medical treatment or time off work occurs and should be forwarded to CIS Claims within five working days at the following address: CIS Claims PO Box 1469 Lake Oswego, OR 97035 After hours or on weekends, leave a voice message with CIS for a return call during business hours.

Claims Notification Process

Claim Submission

Please follow the process below for submitting a claim.

1) Send claim notice to claimspl@cisoregon.org for auto/liability/property claims and claimswc@cisoregon.org for workers compensation claims with attached documents.

2) Complete the form on this page (in the Claim Forms box to the right) that relates to your claim (Workers’ Compensation, Automobile Crash, General Liability, property Claim)

3) If the form is not submitted electronically, please fax to 503-763-3901

Emergency Claim Notification Process

Please utilize the following procedures when reporting serious incidents* or fatalities.

* Serious incidents would include accidents involving injuries requiring admittance to a hospital, police incidents involving use of firearms, public allegations of sexual misconduct involving public officials, or other "high profile" incidents involving potential civil liability.

Contact local emergency response personnel to handle immediate threats to life or property.
Secure the scene.
Follow your Emergency Policy/Procedure for internal response, reporting notification.
Notify CIS Claims at 1-800-922-2684 and ask to be directed to Jim McWilliams (Claims Manager). If you are calling after hours and this is a true emergency, call the emergency claims number, 503-763-3897, and your call will be forwarded to the on-call claims examiner.
Contact your Employee Assistance Program (EAP) for counseling and critical incident debriefing as needed.
Conduct an internal investigation, document facts and submit the appropriate claim form to CIS Claims. Workers’ Compensation claim forms are available online.
If news media are requesting comment, be sure to follow your entity’s policy regarding media contact and public information. If you need assistance in developing such a policy, please contact CIS. Please note to call OR-OSHA at 1-800-922-2689 if a fatality or serious disabling injury requiring hospitalization has occurred. Fatalities must be reported within 8 hours and in-patient hospitalization of an employee within 24 hours.

An incident report may be used if the injured worker is not planning to seek medical treatment. The 801 Claim Form must be completed when medical treatment or time off work occurs and should be forwarded to CIS Claims within five working days at the following address:

CIS Claims
PO Box 1469
Lake Oswego, OR 97035

After hours or on weekends, leave a voice message with CIS for a return call during business hours.