• Worker's Compensation Claim Form

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  • Please make note of the following information:

    Worker's Compensation Insurance Carrier: PMA Management Corp.
    Phone Number: (888) 476-2669

    Address:
      PMA Medical Bills
      P.O. Box 5231
      Janesville, WI 53547-5231

    The HR Office will email you your claim number within 24 hours of your claim submission. If you do not have your claim number prior to seeking medical attention, please provide your physician with our HR contact information -  Annie Steve, 315-445-4155, steveam@lemoyne.edu.

  • For Employee's Supervisor to Complete

    Your supervisor will receive a copy of this form to complete this section.
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