The Division of Workers' Compensation has designed the web enabled system for electronic filing of the Second Injury Fund quarterly surcharge report forms by the employer and/or insurers in lieu of the Division mailing the quarterly reports to self-insurer/group trusts and posting the blank quarterly report forms on our website for commercial insurance companies. This will save postage costs for the Division, ensure accuracy, and streamline the process for companies with credit or zero balances.



The objective is to test, initiate, implement, maintain the reports, and the collection of the Second Injury Fund Surcharge from the companies through electronic filing.



The following explains the guidelines that are to be followed in order to receive and submit the Second Injury Fund Quarterly Report forms electronically.

  1. On Line Report of Second Injury Fund Quarterly Report Forms
  2. Electronic Partnering/Confidentiality Agreement - Must be submitted and received by Division prior to accessing the Log In
  3. Log In