Claim Forms

Auto, liability, and property claim forms
Cities can submit auto, liability, and property claims to LMCIT using any type of format that is most convenient for the city. The most common forms of submission are by using an LMCIT form (found below) or an ACORD form. Cities should submit these types of claims as soon as the city becomes aware of the claim.

Workers’ compensation claim forms
Workers’ compensation claims must be submitted on a First Report of Injury (FROI) form. These types of claims must be submitted within 10 days of the city’s first knowledge of an employee’s injuries. Given a death or serious injury, the information must be reported by phone within 48 hours and a FROI form must be submitted within seven days of the injury.

Minnesota's Workers' Compensation Statute requires that employers provide employees with a copy of the Minnesota Workers' Compensation System Employee Information Sheet at the time the employee is given a copy of the FROI. Cities should make copies of this information sheet and keep with the employee’s FROI.

Read about claims reporting methods
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