Workers' Compensation Toolkit

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This kit is provided to new workers' compensation policyholders and their agents, as well as to all current policyholders when their policies renew. It contains important claims department contact information, instructions, and forms.


Maine Contact Information:

Nationwide Insurance - West Office
One Nationwide Gateway, Dept. 5574
Des Moines, IA 50391-5574
(800) 532-1212
Fax: (800) 562-4339

Harleysville Insurance
PO Box 244
Harleysville, PA 19438-0244
(888) 595-9876
Fax: (800) 441-4118

Agribusiness Mailing Address for Claims Related Mail
1100 Locust St., Dept 3010
Des Moines, IA, 50391-3010
Phone: (800) 228-6700
Fax: (800) 842-1482

 

NOTE: If you experience difficulty opening/accessing the PDF's using the links below:

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Maine Compliance Information

Posting Requirements

Reporting Of Claim By Employer

Penalties for Late Reporting

Physician Selection


Posters and Publications

POSTER - Workers' Compensation Board Notice to Employees Required



Forms

Employer's First Report of Occupational Injury or Disease


Schedule of Dependent(s) and Filing Status Statement






Please Note: The information on this site is maintained by a third-party, Nationwide does NOT warrant or represent that the information will be error-free. Your use of the site is on an as-is basis, at your sole discretion and risk. The site is for informational purposes, and nothing included in the site shall replace the need for qualified legal counsel. We recommend that you consult with legal counsel, agents, or risk managers regarding workers' compensation obligations.

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