Online 1st Report of Injury
Step # 2: Complete your Claims Kit 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.
DOWNLOAD CLAIMS KIT FORMS: Authorization & Notification Forms
(PDF includes: Workers' Compensation Information, Employee Notification and Authorization forms)
For expediency, please submit completed forms via fax. However, you must still mail originals!
FAX TO: Lackawanna Insurance Group @ 570-824-7969
MAIL CLAIM'S KIT FORMS TO:
Lackawanna Insurance GroupPO Box 270Wilkes Barre, PA 18703
