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Get Pinnacol Assurance First Report of Injury 2009

Money. Report all injuries immediately! The information below allows Pinnacol Assurance’s customer service representatives to quickly and accurately process your claim. Use the completed form as a guide when reporting by phone or online to save you time. Don’t wait to report if you don’t have all the answers. POLICY INFORMATION Policy Number: _______________________________ Company Name: ______________________________________________________ Address or Location (if different than mailing.

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