Nationwide

Workers' Compensation Toolkit

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.

Oklahoma Contact Information:

Nationwide Insurance - West Office*
PO Box 182079
Columbus, OH 43218-2079
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
P O BOX 182066
Columbus, OH 43218-2066
Phone: (800) 228-6700
Fax: (800) 842-1482

Below are a few additional tools to help you manage your workers' compensation claim:

Locate medical providers - Are you an employer or injured worker looking for doctors, hospitals or pharmacies? We can help you find local medical professionals.

First Fill program - The First Fill program allows one-time prescription processing before a workers' compensation claim is established, resulting in no out-of-pocket cost for the injured worker. Ask your claims representative for more details.

EBill submission for Medical Providers through Jopari - Nationwide Insurance is registered with Jopari Solutions, Inc. for eBill submission. Call 800-630-3060 or email support@jopari.com for assistance.

EBill submission for Medical Providers through WorkCompEDI - Nationwide Insurance is registered with WorkCompEDI, Inc. for eBill submission. Call 800-267-6909 to speak to Debbie Hoffer (x1311) or Frank Giampetruzzi (x1318), or email info@workcompedi.com for assistance.

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

Open to access the documents

Oklahoma Compliance Information:

Posting Requirements
Reporting Of Claim By Employer
Penalties for Late Reporting
Physician Selection

Posters and Publications

POSTER - Oklahoma Workers' Compensation Notice and Instruction to Employers and Employees Required

POSTER - Oklahoma Workers' Compensation Notice and Instruction to Employers and Employees (Spanish) Required

Forms

Employers' First Notice of Injury

Employee's First Notice of Accidental Injury and Claim for Compensation. (Mandatory Form Color: Light Blue)

Claimant's First Notice of Death and Claim for Compensation (Mandatory Form Color:Cream)

Employee's First Notice of Occupational Disease and Claim for Compensation (Mandatory Form Color: Lilac)

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.

This service uses a proprietary system to pre-fill certain claims office and insurance company data on some forms. This may prompt a request by your Adobe Reader program to "trust" the source of the files. Please designate this as a trusted source in order for that information to be pre-filled for you.

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