Workers’ Compensation claims need to be made within 24 hours of injury, and you may report that information at any time through Champion Claim Service, Inc., by calling 412.881.4560. When making a claim, the following information is needed.
Workers’ Compensation Claims
If you are an employee…
- Address including county
- Your telephone number
- Your Social Security Number
- Date of Birth
- Marital status & number of dependents
- Your job title
- Date you were hired
If you are an employer…
- Address including county
- Name of contact person
- Contact’s phone number
- Type of business/FEIN
- Name of insurance company
- Policy number with dates of coverage
Information pertaining to injury…
- How the employee was injured
- Location of injury on body
- Name and address of treating physician
- Any witness names and their phone numbers
- Where the injury occurred (i.e. street or road name)
Dates relevant to injury…
- Date and time
- Date employer was notified
- Date of disability
- Date of return to work
- Last full day employee was paid
- Date of hire
Upon processing the requested information, CCS will forward copies via mail or fax to the following:
- Lebanon Valley Insurance Company
- Employee
- Employer
- Workers’ Compensation Bureau (if there is lost time)
