How to report a work related injury:

If you are injured at work, you are responsible to notify your employer immediately.  If your supervisor is not available, you should notify Human Resources. You and your supervisor will then need to complete the First Report of Injury Form, Notice of Rights and Duties Form, and Mandatory Notice Acknowledgement Form. Your supervisor will hand the form into Human Resources with a completed Supervisor Evaluation of Work-related Injury or Accident.

It is required that you treat with the Panel Health Care Providers for the first ninety (90) days of treatment, from the date of the first visit to a designated provider.

Unauthorized, non-emergency treatment during the first ninety (90) days with a Non-Panel Health Care Provider will not be paid by your employer or their carrier.

If you choose to treat outside of the list of Panel Health Care Providers after the first ninety (90) days, your employer must be notified within five (5) days of treatment with the Non-Panel Health Care Provider.

In case of emergency, you may seek treatment at the closest Emergency Room.  In such case, you or an immediate family member must notify your supervisor or Human Resources immediately.  Remember, it is important to tell your employer about your injury. 

Send bills to:

P.O. Box 42737
Baltimore, MD 21284
Fax: 410-583-5455

Any questions may be referred to:

Commonwealth of Pennsylvania
Department of Labor and Industry
Bureau of Workers' Compensation
Harrisburg, PA 17104-2501
1 (800) 482-2383

Supervisor Timeline for Reporting Claims