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) 363-8904

Harleysville Insurance
PO Box 182079
Columbus, OH 43218-2079
(800) 889-9872
Fax: (800) 363-8904

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 -

Nationwide Workers’ Compensation accepts eBill submission from medical providers in all states on all claims. Providers seeking eBill submission of medical bills may do so by contacting their own eBill clearinghouse, by registering with a clearinghouse of their choice, or by contacting WorkCompEDI.com.

WorkCompEDI, Inc.
(800) 297-6909
nationwide@workcompedi.com
Payor ID: CB151 (Nationwide, Allied, Harleysville)
Payor ID: 28223 (Nationwide Agribusiness)

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 - ** Effective 9/1/18, may only be filed by EDI, paper submissions not accepted. **

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.

The documents in this system use Adobe Reader to view PDF files. If you do not have Adobe Reader, you may download the latest version here for free. Download Adobe Reader Here