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The Employers First Report of Injury or Illness provides information on the claimant, employer, insurance carrier and medical practitioner necessary to begin the claims process. Details of the claimants employment and circumstances surrounding the injury or illness are also requested.
Form LIBC-344 First Report of Injury (FROI). As soon as you have been notified of a work-related injury, please fill out this form and submit it to EMPLOYERS. This form must be completed within 10 days from notice of a work-related injury. Fatalities must be reported within 24 hours.
You must report your injury to your employer within 120 days. After that, you become ineligible to receive benefits. If you inform your employer of your injury within 21 days, you can be awarded benefits as of the date of your injury.
The Form WC-701 is used to report to the Workers Disability Compensation Agency payment of weekly comp benefits made to the employee. It has the date of injury, part of body impacted, and nature of the injury. It also includes the wage loss calculation.
You must give notice, preferably in writing, to your supervisor or manager at work within 21 days of your accident or whatever incident caused you harm. If you wait more than 120 days to inform your employer, youll lose your right to workers comp benefits.
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How to File a Workers Compensation Claim in PA Inform Your Employer of Your Injury. Seek Immediate Medical Attention. File Your Claim With the Pennsylvania Department of Labor and Industry. Fill Out All the Required Workers Compensation Claim Forms.
How to File a Workers Compensation Claim in PA Inform Your Employer of Your Injury. Seek Immediate Medical Attention. File Your Claim With the Pennsylvania Department of Labor and Industry. Fill Out All the Required Workers Compensation Claim Forms.

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