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This version of the form is not currently in use and is provided for reference only. Download this version of
State Form 12386-B
for the current year.
State Form 12386-B Certification for Worker's Compensation Carriers - Indiana
What Is State Form 12386-B?
This is a legal form that was released by the Indiana Workers' Compensation Board - a government authority operating within Indiana. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is State Form 12386-B?
A: State Form 12386-B is a certification form for worker's compensation carriers in Indiana.
Q: Who needs to submit State Form 12386-B?
A: Worker's compensation carriers in Indiana need to submit State Form 12386-B.
Q: What is the purpose of State Form 12386-B?
A: The purpose of State Form 12386-B is to certify that a worker's compensation carrier is authorized to operate in Indiana.
Q: Is State Form 12386-B mandatory for worker's compensation carriers?
A: Yes, worker's compensation carriers in Indiana are required to submit State Form 12386-B.
Q: Are there any fees associated with State Form 12386-B?
A: No, there are no fees associated with submitting State Form 12386-B.
Q: What information is required on State Form 12386-B?
A: State Form 12386-B requires information about the worker's compensation carrier's name, address, contact information, and other relevant details.
Q: Are there any deadlines for submitting State Form 12386-B?
A: Yes, worker's compensation carriers in Indiana must submit State Form 12386-B annually by a specified deadline.
Q: What should I do if I have questions about State Form 12386-B?
A: If you have any questions about State Form 12386-B, you should contact the Indiana Department of Insurance for assistance.
Form Details:
- The latest edition provided by the Indiana Workers' Compensation Board;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of State Form 12386-B by clicking the link below or browse more documents and templates provided by the Indiana Workers' Compensation Board.
