Indiana Workers' Compensation Board Forms
The Indiana Workers' Compensation Board is responsible for administering the workers' compensation system in the state of Indiana. Their main purpose is to ensure that employees who have suffered work-related injuries or illnesses receive the appropriate benefits and help in resolving any disputes that may arise in relation to these claims. The board oversees the handling of workers' compensation claims, provides information to employers and employees about their rights and responsibilities, and helps in determining the liability and compensation for workplace injuries or illnesses.
Documents:
30
This form is used for an agreement between employee and employer in Indiana regarding compensation.
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This form is used for filing an application for adjustment of claim in the state of Indiana. It is used to request a review and potential adjustment of a previously submitted claim.
This document is an agreement between parties in the state of Indiana for a lump sum payment. It outlines the terms and conditions of the payment and serves as a legally binding contract.
This form is used for the agreement to compensation between the dependents of a deceased employee and the employer in the state of Indiana.
This Form is used for reporting a physician's medical assessment or evaluation in the state of Indiana.
This form is used for notifying the state of Indiana when you are unable to determine your liability or need additional time to do so.
This form is used for requesting a provider fee for assistance in the state of Indiana.
This form is used for employees in Indiana to waive the requirement of an examination by their personal physician.
This form is used for reporting the termination of temporary total disability (TTD) or temporary partial disability (TPD) in the state of Indiana.
This Form is used for notifying workers about their coverage for worker's compensation and occupational diseases in the state of Indiana.
This Form is used for certification of insurance carriers in Indiana to report the number of workers' compensation policies they have written or renewed. It helps the state track the insurance coverage provided to workers in case of job-related injuries or illnesses.
This document is used for applying to adjust a claim for provider fee in the state of Indiana.
This form is used for issuing a legal command for the production of documents or testimony in the state of Indiana.
This Form is used for requesting assistance in the state of Indiana.
This form is used for applying for a Worker's Compensation Clearance Certificate in the state of Indiana.
This Form is used for requesting public records in the state of Indiana.
This document is the Attorney Oath specific to the state of Indiana. It outlines the commitments and responsibilities that attorneys in Indiana must uphold.
This form is used by employers in Indiana to apply for permission to carry risk without insurance. It is required for employers who want to self-insure their workers' compensation coverage.
This form is used for applying for Second Injury Fund benefits in the state of Indiana. It helps individuals who have sustained a second injury and are eligible for compensation.
This Form is used for reporting and summarizing the benefits paid in the state of Indiana.
