Forms
Lackawanna Insurance provides access to a variety of online and downloadable forms for your convenience.
Reporting an InjuryNeed 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. |
Claims KitIf you do not have your original Employer Claims Kit, you may download the documents online.
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Supplemental Underwriting FormsThese forms are individually designed to specific class codes and industries, and should be completed and provided to your underwriter so the prospective risk's can be better understood for acceptability and pricing analysis. Now you can download PDF versions of the forms on our website!
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- FOR AGENTS ONLY - |
Account Loss RunsAgents 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.
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Please feel free to Conatct Us if you don't see the form you need.
