Workers Compensation Online Claim Reporting

This kit is provided to new workers’ compensation policyholders and their agents, as well as to all current policyholders when their policies renew. It contains important claims department contact information, instructions, and forms. Use of the forms available on this site are intended for the exclusive use of our policyholders and their agents.

Report Workers Compensation Claims

To report a Workers Compensation claim online, click on the box below.

Note: Enter the Injured worker’s legal name on the injury reports as it appears on their social security card as well as their social security number. This information is required as per Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007.

Report a New Claim

Filing a Workers Compensation Claim

To report a workers compensation claim other than via our online portal, please send new loss notices via email to or mail to:

Rockwood Casualty Insurance Company
Attn: Claims Dept.
654 Main St.
Rockwood, PA 15557
Fax: 814-926-5215
Phone: 800-837-9062

Statement of Wage Forms


Additional Forms

Select one of the forms above, fill out the form and save it. You can email the form to or as an attachment when using the report a new claim link above on page 4 of the form.

Having trouble with the PDF opening in your web browser? Try these solutions from Adobe.

Office Locations

654 Main St.
Rockwood, PA 15557

Toll-Free Phone: 800-837-9062
Phone: 814-926-4661
Fax: 814-926-3249

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