Billing Information

Republic Indemnity accepts the following payment methods:

  • Credit Card (Visa or MasterCard)
  • Electronic Funds Transfer using your Checking Account

Payments can be processed as follows:

  • Over the phone by calling Republic Indemnity at (800) 821-4520
  • Online at (Registration Required)

If Your Employee is Injured at Work

If your employee’s need for treatment appears urgent — for example, bleeding profusely, unconscious or may be having a heart attack — get them to the nearest emergency room or call 9-1-1.

For non-emergency services, you must approve treatment at a Medical Provider Network (MPN) facility within one working day after you receive a claim form from your employee.

Note: If your employee has pre-designated a personal physician to treat on-the job injury or illness, the employee should go to this physician.

Click here to search for a provider or click here to learn about Republic Indemnity Medial Provider Network FAQs

Republic Indemnity Claim Representatives can assist you with completing the required claim forms by calling them as follows:

San Francisco—Northern California claims 
Phone: (415) 981-3200 or (800) 662-1485

Encino—L.A., Orange, and Ventura County 
Phone: (818) 990-9860 or (800) 821-4520 

San Diego—San Bernardino, Riverside, and Imperial County
Phone: (858) 292-7002 or (800) 222-6752 

Arizona—Arizona, Colorado, Kansas, Missouri 
Fax: (602) 912-9509 
Phone: (602) 912-9505 or (800) 340-0001 

Claim Forms

DWC-1 Workers Compensation Claim Form (English & Spanish) – to be completed out by the employee and employer

Employers Report of Occupational Injury or Illness – to be completed by the employer

Loss Control

Republic Indemnity provides Loss Control Resources for their policyholders that can be accessed online.  Visit their Loss Control Resources page to learn more about topics such as:

  • Developing a Commercial Fleet Safety Program
  • Developing a Confined Space Program
  • Emergency Action Plans
  • Ergonomic Safety Program
  • Create an Accident Investigation Form
  • Develop a Bloodborne Pathogens Plan
  • Learn about Ergonomic Safety Training and how to implement it in your Workplace
  • Download an Ergonomic Workstation Diagram
  • Create a Forklift Safety Program