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How to File a Claim

 


Step # 1: Submit First Report Injury Form


The First Report of Injury form must be submitted in a TIMELY manner*.  Just use our quick and easy ONLINE First Report of Injury Form and you are finished in just minutes. You will receive a confirmation that your First Report of Injury submission was successful.

If you prefer to fax or mail the First Report of Injury form, see "Alternative Methods for Reporting an Injury".

 

Important Notice
If you have a panel list of physicians that includes the appointment scheduling services by Premier Comp Solutions please be advised that scheduling an appointment is NOT the same as reporting the injury. You must submit a First Report of Injury form to Lackawanna Insurance Group.

 

* FILE WITHIN TIMELY MANNER: The Pennsylvania Bureau of Workers'™ Compensation ONLY accepts electronic injury reports from Insurers and requires submission of an injury report within 48 hours for injuries resulting in death and within 7 days for all other injuries. If you have not submitted your claim already, please do so immediately.

For Lackawanna Insurance Group to timely report injuries to the Pennsylvania Bureau of Workers' Compensation the insured must immediately after an injury complete and submit our First Report of Injury Form.  It is necessary to complete at least the required fields on our First Report of Injury Form since this information is required by the Pennsylvania Bureau of Workers'™ Compensation.

 


Step # 2: Complete your Claim Forms


In addition to reporting the injury (First Report of Injury form), please fax or mail their signed Workers' Compensation Information, Employee Notification and Authorization forms from the Claims Kit.

 

Claims Kit & Forms

If you do not have your original Employer Claims Kit, use the links below to download the required forms: Report  a    Claim Online

Individual Forms

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Step # 3: Submit your Original Claim Forms


For expediency, please submit completed forms via fax. However, you MUST still mail originals!


Mail Originals

FAX TO: Lackawanna Insurance Group @ 570-824-7969


MAIL CLAIM FORMS TO:

Lackawanna Insurance Group
PO Box 270
Wilkes Barre, PA 18703

 

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