To file a complaint with the Office of the Workers' Compensation Fraud Inspector General via this website, please complete the information below. This is a sample form only.Claimant should fill out the form on their insurer or administrator's website and submit the form directly to them. How to fill out the Subrogation Workers Compensation Accident Form? This form is designed as a general form for use with respect to all claims. Some of the questions may not be applicable to your particular claim. A leading claims and risk management solutions provider, we partner with you to mitigate risk and achieve outcomes that matter most to your ongoing success. The employer may have separate insurance coverage covering the co-worker. The law grants a right of subrogation to the employer against any third party tortfeasor who is responsible for injuring their employee.