Human Resources » Worker's Compensation Information

Worker's Compensation Information



  • In an emergency, take your injured employee to the nearest emergency facility.
  • For all work-related injuries, provide the list of panel physicians to the injured employee.
Please refer to the Flow Chart for specific directions.  All forms can be found below.
The injury report is the injured employee’s statement of what happened.
Have the injured employee complete this form and email the completed form to the HR Office, or
Employee Acknowledgement of Rights
  • This form explains the employee’s rights under the Pennsylvania workers’ compensation law that must be signed by the employee at the time of injury.                                  
  • Send this copy to the HR Office along with the Injury Report Form.
  •  Medical Authorization Form
    •  This form authorizes Eastern Alliance to request medical records related to the injured employee's claim
  • Work Status Form and Modified Duty Notice
    •  Have the injured employee take these forms to his/her treating physician.
    Provide a signed copy of the form to the HR office.
Physicians Panel for work related injury physicians.
Please contact a physician on this list to be evaluated.
Accident Investigation Form needs completed by Supervisor with the
injured employee to determine corrective actions to prevent future incidents.
Pharmacy Information
If you have a Worker's Compensation claim, you will be receiving a KeyScripts
prescription card in the mail.  Utilize this card when filling your prescriptions.
If you need the prescription prior to receiving your card, go to the pharmacy
on the Keyscripts list, under the pharmacy information link above and have your
claim number and the toll free Keyscripts phone number, 1-866-446-2848.  
The pharmacist will be able to confirm the claim and fill the prescription.