41908 Route 6 | PO Box 7 | Wyalusing, PA 18853


Workers’ Compensation Claims

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.

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)
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