Article
Section
Forms
- Application for Review by Full Board - SF 1042
- Agreement to Compensation - SF 1043
- Report of Attending Physician - SF 2118
- Application for Adjustment of Claim for Provider Fee - SF 18487
- Agreement to Compensation Between the Dependents of Deceased Employee and Employer - SF 18875
- Application for Adjustment of Claim - SF 29109
- First Report of Injury - SF 34401
- Agreement Between Parties for Lump Sum Payment - SF 34873
- Subpoena - SF 34877
- Notice for Worker's Compensation and Occupational Diseases Coverage - SF 36097
- Report Of Temporary Total Disability (TTD)/Temporary Partial Disability (TPD) Termination/Reduction - SF 38911**
- Request for Assistance - SF 45442
- Application for Worker's Compensation Clearance Certificate (English) - SF 45899
- Application for Worker's Compensation Clearance Certificate (Spanish) - SF 55718
- Notice of Inability to Determine Liability / Request for Additional Time - SF 48557**
- Application for Second Injury Fund Benefits - SF 51247
- Request for Prosthetic Repair or Replacement - SF 51702
- Provider Fee Request for Assistance - SF 52875
- Request for Public Record - SF 53811
- Employee Waiver of Examination by Personal Physician - SF 53913
- Notice of Denial of Benefits - SF 53914**
- Notice of Suspension of Compensation and/or Benefits - SF 54217**
- Certification of Insurance Carrier as to Number of Worker's Compensation Policies Written or Renewed - SF 55310
- Self-Insurance Forms
- 2nd Injury Fund Forms
**Please note that all forms marked by an asterisk are required to be submitted online via the Forms Portal. Forms submitted to the Board in hard copy prior to being submitted online will be rejected.
Online Services
- Billing Review Service Registration
- CAUSE System
- Check Informal Dispute Status
- Confirm Employer's Worker's Comp Coverage
- Confirm First Report Filing
- Contractor Search
- Coverage Election Search
- Dispute Termination of Benefits
- Find a Comp Attorney
- Forms.IN.gov
- Forms Portal
- Non-Compliant Employer Reporting
- Online Payment Options
- Public Records Request
- Request a Certificate of Compliance
- Search Disputed Claims