Report Fraud

Please fill in the form below as it relates to a Beacon Workers' Compensation claim. Answer the questions as completely as possible. If you wish to remain anonymous you may, but if not, your identity will be kept strictly confidential. When you complete the online form, select the Submit button. This will cause an electronic email to be automatically sent to the Beacon Special Investigative Unit (SIU).
Name (optional):
Name of the Person or company that you are reporting:
Enter the person or company's address if you know it:
Enter the person's social security number if you know it:
Enter the person's date of birth or approximate age:
Do you know the person's employer's name and address?
Does the person use any other names or alias' name and address?
Date that the incident occurred or approximate calendar time period:
Why do you feel this may be a fraudulent claim?
Briefly describe the incident:
Comments:
I do not wish to provide my name:
I will provide my contact information, but all information will remain confidential:
Name:
Job Title:
Phone Number :
Email Address: