Workers’ Compensation information and forms for the state of PA

Workers’ Compensation Insurance can seem complicated to administer. There are many forms and various specific state regulations concerning postings and employee notification. To get the help you need to ensure employees understand coverage’s and how to report a work place injury, select the link located below.

• 221-10000 – Claim Kit Cover Letter
  Letter from The Hanover welcoming the employer to the insurance plan, includes instructions for claim reporting and creating medical provider panels.
• 221-10001 – Take Control of Workers' Compensation Costs
  This guidance will help ensure the best outcome for you and your employees following a work related injury.
• WC7826g – Remember: It Is Important To Tell Your Employer About Your Injury
  Required to be conspicuously posted at the employer's place of business so all employees have access to it.
• IA-1 – First Report of Injury or Illness
  This form is completed by the employer to report an on the job injury or accident involving an employee.
• 221-8804 – Notice: Medical Treatment for Your Work Injury or Occupational Illness
  Required to be conspicuously posted at the employer's place of business so all employees have access to it. A copy must be provided to an injured employee at the time of injury. Employer can choose physicians at Talispoint or by contacting the workers' compensation claims adjuster at Hanover by calling 1-800-628-0250.
• PAWCINFO – PA Workers’ Compensation Information
  Employer must provide this notice to new employees at time of hire.
• PAEERD – PA Employee’s Rights & Duties
  Employer must provide this notice to new employees at time of hire.