Due to system maintenance, our Agency Link system will be unavailable beginning Friday April 21, 2017 at 5:00 PM EDT. Normal Agency Link usage will resume Monday April 24th at 6:00 AM EDT. Please contact your underwriter with any questions. We apologize for the inconvenience.  

Forms

Lackawanna Insurance provides access to a variety of online and downloadable forms for your convenience.

 

 

Report  a Claim Online

Reporting an Injury

Need to file a claim?      . . . No problem!

We provide three (3) methods to submit the First Report of Injury form, including our quick and easy Online First Report of Injury Form.

Learn How to File a Claim

 

 

Report a Claim Online

Claims Kit

If you do not have your original Employer Claims Kit, you may download the documents online.

 

Full Claims Kit


- FOR AGENTS ONLY -

Loss Run Reports

Account Loss Runs

Agents are given FAST ACCESS to Account Loss Runs. As an affiliated agent you may request your Account Loss Runs online and your reports will be generated and emailed to the email address on file in one business day or less.

 

Request Account Loss Runs

Supplemental Underwriting Forms

Supplemental Underwriting Forms

Complete these class codes and industry specific underwriting forms and provide to your underwriter so the prospective risk's can be better understood for acceptability and pricing analysis.

 

Supplemental Underwriting Forms

Please feel free to Conatct Us if you don't see the form you need.