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Updated 02/06/2023-Page 1 of 1LEHIGH COUNTY THE PENNSYLVANIA STATE UNIVERSITY AGRICULTURAL EXTENSION OFFICE Workers\' Compensation Program: Designated Health Care Providers NOTICE TO EMPLOYEES IN

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How to fill out workers comp claim between

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Notify your employer immediately once you are injured at work.

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Obtain the necessary claim forms from your employer or workers' compensation insurance provider.

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Fill out the claim forms accurately and truthfully, including details of the injury and how it occurred.

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Submit the completed claim forms to your employer or the workers' compensation insurance provider within the specified time frame.

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Workers who have been injured or become ill as a result of their job duties.

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Employers who are legally required to provide workers' compensation insurance coverage for their employees.

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