CompSource Oklahoma - Report Fraud

Workers’ compensation fraud affects every member of society. We all, in some way, pay the price for this crime. Your assistance in reporting fraud or the suspicion of fraud is of great value to those who investigate this crime. This form is designed to assist you in reporting. The more information you can provide, the more help it is to the investigator. The items marked with an asterisk (*) are essential to opening an investigation. All other information you can provide will enhance the investigator’s ability to expeditiously process the information.
You can remain anonymous.

INFORMATION ABOUT THE PERSON (OR COMPANY) SUSPECTED OF FRAUD
*Name of Person: SSN:
Name of Company: Phone:
Address:
City: State: Zip:
Date of Birth or Age: Race: Sex: Ht: Wt:
Hair Color: Facial Hair: Scars or Marks:
Vehicle Description: Any Nicknames or Alias':
Is the person working? If yes, where?
How long? Hours: Type of Work:
*Why do you suspect fraud is being committed?
If other, please explain:
Do you know of any prior injury? If yes, where? When?

INFORMATION ABOUT YOU
Name: Phone:
Address:
City: State: Zip:
Relationship to person/company suspected of fraud:
May we use your name? Are you willing to assist at a later date?
Have you called before?

Please click only once to avoid transaction duplication.

If you have questions regarding this form, or any other fraud related questions, please don’t hesitate to call us at (405)962-3704 or 1-800-899-1847, or just send us an e-mail.