When you file your claim on State Fund Online, the system will guide you through completing the Employer’s Report of Occupational Injury or Illness (form e3067), completely online. You will not need to download and fill out the PDF version of the form. In State Fund Online, this form is referred to as First Report of Injury.

  1. Log into State Fund Online.
  2. From the menu bar on your State Fund Online dashboard, click the CLAIMS dropdown.
  4. Next, select the relevant policy coverage period during which the injury happened.
  5. Read “Reminder of Employer’s Responsibilities” and press CONTINUE.
  6. Fill out the employee information form fields.
  7. Enter your employer information.
  8. Enter the injury or illness information. Note: in the “Time of Injury” fields, you’ll need to enter the time as a four-digit number. Example: If time of injury was 8:15 AM, it must be entered as 08:15 AM.
  9. Enter injury information including how it occurred, physician and hospital info.
  10. Review report, then press SUBMIT.
  11. After submitting your report, you will receive a reference number confirming your submission. Note: the reference number is not your claim number. The claim number will be assigned once your submission is reviewed and your file created.