Church Mutual Insurance Co.
P.O. Box 342
Merrill, WI 54452-0342
Phone: 1-800-554-2642 Fax: (715)539-4651
Contract No. 0500002-07-479090 (Effective 07/01/12 – 06/30/13)
The Diocese of Raleigh provides a comprehensive workers’ compensation insurance program at no cost to employees. This program covers disability incurred through accident or occupational disease—arising out of, and in the course of, employment—that requires medical, surgical, or hospital treatment. In order to be eligible for workers’ compensation benefits, the injured person must be a paid employee of the Diocese.
To file a Workers’ Compensation Claim or report a work related injury, please follow the procedure below: (NOTE: This is an updated procedure, effective March 7, 2011)
- All work related injuries must be filed within 5 days after knowledge of the injury or accident.
- The location must complete a NC Industrial Commission Form No. 19 provided by Church Mutual. Download the form here (PDF).
- The completed original form must be mailed or faxed directly to the Human Resources Department, C/O Kelly Kosuda, 7200 Stonehenge Dr., Raleigh, NC, 27613; or fax: 866-955-8459.
- A copy of the claim should be kept at your location.
- All subsequent bills relating to the claim must be sent to directly to the Human Resources Department following the same procedure as above.
Human Resources Coordinator
7200 Stonehenge Dr.
Raleigh, NC 27613
Phone: (919) 821-9714
Fax: (866) 955-8459