Report Fraud Submitters Name: (Optional): Name of the Suspected Individual: Suspected Individual's City and State: Suspected individual's Zip Code: Name of the Business for Whom the Suspected Individual Worked at the Time of Alleged Injury: Business City and State: Business Zip Code: Activity Believed to Be Fraudulent: 12 + 4 = Submit Fraud Report Claims New York Claims Information New Jersey Claims Information PA/DE Claims Information Return-To-Work Program Report Fraud Loss Control Risk Management Conference Oryx Education Center If you have a question related to a claim, please call 315-410-0210Employer’s Responsibility for Filing a Claim
