Workers’ Compensation forms for each state we serve are available as a PDF and can be printed to be filled out and submitted to Cooperative Mutual Insurance Company by mail or fax.

Cooperative Mutual Insurance Company
3905 South 148th Street, Suite 100
Omaha, NE 68144
Fax: 402-408-0601

3905 South 148th Street, Suite 100                                              Omaha, NE 68144                                                                                            800-642-8572