Preferred Provider Nomination Form

Engaging a Workplace Rehabilitation Provider for a worker’s injury claim can significantly reduce prolonged absences and improve return-to-work outcomes. Preferred Provider agreements streamline and enhance the rehabilitation and return-to-work process by formalising collaboration between insurers, employers, and Easec.

Complete the below form to nominate Easec as your preferred provider.

We are specialists in workplace rehabilitation and ready to support your people.

Company Details

Contact Person Details

Insurer Details

Please provide Workers Compensation details for the states that you would like to nominate Easec as your preferred provider in.

Insurer States / Territories *
Please enter Workers Compensation Insurer, Policy Number and Insurer Contact Name (if known) for each selected area.

Agreement Acknowledgement