Workers’ Compensation Claim Kit – Pennsylvania

Who will handle your claims?
The Milwaukee Regional Claim Office will handle your Pennsylvania claims.

Phone: 800-242-4566
Jeanine Ramstack, AVP

Please direct all general correspondence to:

Email:    [email protected]
Fax:        877-622-6911
Mail:      PO Box 14139, Lexington, KY  40512

How to report Workers’ Compensation claims?

To report via the Internet: Log on to the Crum & Forster website at https://cfconnect.cfins.com Use your assigned User ID and Password. If you do not have a current User ID, please contact your local Crum & Forster Claims or Marketing resource.

To report e-mail: [email protected]

To report via fax: 1-877-622-6218

To report claims via telephone: 1-800-690-5520

(7 day/24 hour toll free reporting line for all states)

  • In the event of a serious or fatal injury, notify the local claim office immediately by telephone.

What forms and pamphlets does the employer need to be aware of?

WC Posting Notice

State specific posting notices are available on our website.

http://www.cfins.com/claims/workers-compensation-claims/

Employer’s First Report of Injury (LIBC – 344)

If you report the claim via the Internet or by telephone, you do not need to fill out this form. If you report the claim via fax, complete this form and fax it to Crum & Forster at the fax number provided above.

PA-Employer’s First Report of Injury

 

Statement of Wages (LIBC – 494C)

File this form with the carrier, claimant, and claimant’s representative when the claimant is losing time from work.

PA-Statement of Wages

What is the Waiting Period for Lost Wages in Pennsylvania?
The waiting period is 7 days. If the employee is off for more than 14 days, the first 7 days are paid retroactively.

What is the Choice of Physician Rules in Pennsylvania?

Provider Selection
Employer/insurer may direct for the first 90 days of treatment after the first visit, by use of a panel posting. If there is no list, the employee can select the treating provider.

Provider Lists
Provider lists and directories may be utilized. There is a state-mandated posting (Panel).

1. The panel must include at least six designated providers. Four may be coordinated care organizations (CCO) or hospitals/facilities, and no fewer than three must be physicians.

2. The list must include the specialty of the provider.

3. If the list includes a CCO, the employer may not individually list any provider participating in that CCO if those individually listed providers are bound by the terms of the CCO for treatment.

4. Employer must provide written notice to all injured employees of their rights.

Notice of Injured Worker Rights and Responsibilities

PA-Injured Worker Rights and Responsibilities

 

Workers Compensation Information Notice – Additional

PA-Workers Compensation Notice

The above two notices must be provided to every employee at the time of hire and immediately after the injury, or as soon thereafter as possible under the circumstances of the injury.

Preferred Provider Organization Network (PPO)

Crum & Forster has a PPO network available. Follow the instructions below to access the PPO Network:

Logon to the website at: https://www-sf.talispoint.com/conduent/cfi/

  • Search by Provider Address, Name or Region
  • Select the Distance, Provider Type and Specialty
  • Results can then be exported to a directory or excel.
  • You can obtain a Map List or text message by selecting a specific provider

Where should all medical bills be sent?

Crum & Forster
PO Box 14801
Lexington, KY 40512

Important Websites

Pennsylvania Department of Labor and Industry / Bureau of Workers’ Compensation-http://www.dli.pa.gov/Businesses/Compensation/Pages/default.aspx

Multi-State Information- http://www.workerscompensation.com/