Indiana Workers' Compensation Information



Please Note: for Claims assistance or questions about coverage and exemptions You will need to call one of the numbers listed below.

Also be aware that the Workers' Compensation Assistance Offices in different states may go by different names such as "Industrial Accidents".
These are the only numbers that we are aware of and have available for Indiana Workers' Compensation.

Indiana Workers' Compensation Telephone Directory


Worker's Compensation Board - Toll Free: 800-824-COMP

WCB Director of Compliance: 317-232-5922

WCB Second Injury Fund: 317- 232-3810

Fraud - Toll Free - Hot Line: 800-403-0864

Bureau of Rehabilitation Services: 877-241-8144

Rehabilitative Services - Mailing Address: 800-545-7763

Hearing District 1 - Case Coordinator: 317-233-3908

Hearing District 2 - Case Coordinator: 317-233-3908

Hearing District 3 - Case Coordinator: 317-232-3808

Hearing District 4 - Case Coordinator: 317-232-3808

Hearing District 6 - Case Coordinator: 317-233-5397

WC Board - Walk ins Phone # if Office is locked : 317-233-3009

Disabilities Ombudsman - General Information: 800-545-7763

Division of Disability & Rehabilitation: 800-545-7763

Manager of Information Technology: 317-233-0396

WC PPI Approval Division: 317-232-3825

WC PPI Approval Division: 317-232-3817

WC Board Chairman Linda Hamilton: 317-232-3811

WC Case Coordinator to Board Member Sandra O'Brien: 317-233-3908

WC Case Coordinator to Board Member A. James Sarkisian: 317-233-3908

WC Case Coordinator to Board Member Daniel Foote: 317-233-3009

WC Case Coordinator to Board Member Diane Parsons: 317-233-3009

WC Case Coordinator to Board Member Doug Meagher: 317-233-5397

WC Case Coordinator to Board Member Kyle Samons: 317-233-5397

WC PPI Approval Division Board Member: 317-232-3807

Occupational Safety Standards Commission: 317-232-2691

Department of Insurance - Commissioner Amy L. Beard - General Number: 317-232-2385

Records Division: 317-232-7225

Clerk of the Appellate Courts: 317-232-1930

WCB Executive Administrator Mary Taivalkoski: 317-232-3811

WCB Paralegal Darren Dye: 317-233-3384

WC Case Coordinator Beth Wallace: 317-233-3908

WCB Provider Fee/Intake Division: 317-232-5922

OSHA - Indiana State Plan: 317-232-2693

Forms & Publications


Welcome to the most extensive library of workers' compensation forms available anywhere. Almost 3,600 forms are available for your immediate download and use. Our forms, all of which have been custom programmed by WorkersCompensation.com for Type & Save functionality, are available for individual purchase below.

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Some "Revision Dates" may be displayed as part of the Description.

NOTICE

As of 2/19/2021, SF 36097 can be submitted to the Board electronically. Effective 4/19/2021, paper submissions of SF 36097 will no longer be accepted by the Board and those sent in or dropped off will be destroyed. Please update your current submission process from mailing in SF 36097 to online submission. **Please note that all forms marked by asterisks 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.

(34401) First Report of Injury 1/02
(2118) Report of Attending Physician 8/11
(Form01042) Application for Review by Full Board 2/98
(18487) Application for Adjustment of Claim for Provider Fee 1/15
(52875) Provider Fee Request for Assistance 11/14
(29109) Application for Adjustment of Claim 6/05
(Form01043) Agreement to Compensation 3/09
(38911) Report of Temporary Total Disability (TTD) / Temporary Partial Disability (TPD) Termination / Reduction 1/14
(45442) Request for Assistance 5/06
(48557) Notice of Inability to Determine Liability/Request for Additional Time 7/12
(51247) Application for Second Injury Fund 2/03
(51702) Request for Prosthetic Repair or Replacement N/D
(34873) Agreement Between Parties for Lump Sum Payment 4/12
(18875) Agreement to Compensation Between the Dependents of Deceased Employee and Employer 5/10
(53913) Employee Waiver of Examination by Personal Physician 4/09
(54217) Notice of Suspension of Medical Benefits 3/13
(53914) Notice of Denial of Benefits 7/12
(53811) Request for Public Record 5/15
(36097) Notice for Workers' Compensation and Occupational Diseases Coverage 6/15
(34877) Subpoena 5/10
(Guidelines) Workers' Compensation Self Insurance Guidelines 2021
(si-1) Employer's Application for Permission to Carry Risk Without Insurance 2021
(si-2) Surety Bond 2003
(si-3) Certificate of Excess Insurance 2003
(si-4) Parental Indemnity Agreement 2003
(si-5) Employer's Request to Include a Subsidiary within its Self-Insurance Program 2012
(si-7) Trucker's Supplemental Application 2003
(12386-b) Certification of Workers" Compensation Carriers N/D
(55310) Certification of Insurance Carrier as to Number of Workers' Compensation Policies Written or Renewed 6/13
(45899) Application for Workers' Compensation Clearance Certificate 3/15
(55718) Application for Workers' Compensation Clearance Certificate (Spanish) 3/15
(TPAApplication) Service Company Application for Permission to Serve Indiana Self-Insured Employers N/D
(12386) Self-Insured Employer Certification N/D

  • 631 IAC 1-1-2 Forms; publication and distribution of pamphlets

  • 631 IAC 1-1-3 Rules of practice in proceedings

  • 631 IAC 1-1-4 Pleadings in subsequent proceedings

  • 631 IAC 1-1-5 Pleadings and papers to be printed or typewritten; filing; service

  • 631 IAC 1-1-6 Plaintiffs

  • 631 IAC 1-1-7 Defendants

  • 631 IAC 1-1-8 Answers; affirmative defenses

  • 631 IAC 1-1-9 Disclaimer

  • 631 IAC 1-1-10 Expediting proceedings; notice of hearings; continuances

  • 631 IAC 1-1-11 Stipulations

  • 631 IAC 1-1-12 Testimony; depositions

  • 631 IAC 1-1-13 Pleadings or depositions in foreign language; translation

  • 631 IAC 1-1-14 Foreign plaintiffs; power of attorney

  • 631 IAC 1-1-15 Facts upon review; additional evidence; oral arguments

  • 631 IAC 1-1-16 X-ray films; admissibility

  • 631 IAC 1-1-17 Number of witnesses; challenging jurisdiction of board; insurance as proof of compliance

  • 631 IAC 1-1-18 Advice and information furnished by executive administrator

  • 631 IAC 1-1-19 Powers and duties of board's executive administrator

  • 631 IAC 1-1-20 Record of claims; electronic record

  • 631 IAC 1-1-21 Certified copies of records, orders, and transcripts

  • 631 IAC 1-1-22 Appeal to court of appeals

  • 631 IAC 1-1-23 Representing litigants before board

  • 631 IAC 1-1-25 Claims for fees; disputes

  • 631 IAC 1-1-26 Compensation agreements; failure to make payments

  • 631 IAC 1-1-27 Time period of payments; memorandum of termination

  • 631 IAC 1-1-28 Reports by employers

  • 631 IAC 1-1-28.5 Exempt entities

  • 631 IAC 1-1-29 Self-insurers; application for certification

  • 631 IAC 1-1-30 Request for certification of compliance

  • 631 IAC 1-1-31 Second injury fund

  • 631 IAC 1-1-32 Medical provider fee claims

  • 631 IAC 1-1-33 Fees for mediation by the board

    • Title 22 Indiana Worker's Comp Code

    Title 27 Insurance