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Pennsylvania and Delaware Claims Detail

Below are many of the common claim forms you will need when filing a claim in Pennsylvania and Delaware. 

Employer Claim Information and Forms

Document What It Is When To Use/File

Welcome kit

Welcome letter for employers entering the Oryx Insurance construction program. Kit includes welcome letter, contact listing and information on our loss control services.

General use

Contact Listing

State specific claim contacts

Use as directed

LIBC-344 REV 1-01

Pennsylvania Employer’s Report of Occupational Injury or Disease

Whenever an injury occurs

DOC. NO. #60-07-01-90-10-04

Delaware Employer’s Report of Occupational Injury or Disease

Whenever an injury occurs

Pharmacy Benefits

Information on the injured employee’s pharmacy benefits for all medications associated with his/her work-related injury.

 

If you have a question related to a claim, please call 315-410-0210

Employer’s Responsibility for Filing a Claim

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