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Reset Form INDIANA WORKER S COMPENSATION BOARD 402 West Washington Street Room W196 Indianapolis IN 46204 EMPLOYEE WAIVER OF EXAMINATION BY PERSONAL PHYSICIAN State Form 53913 4-09 INSTRUCTIONS Please have claimant complete this form. Submit together with Agreement to Compensation Form 1043. I understand that pursuant to the Workers Compensation Act of Indiana I have the right to have an examination by a qualified physician of my choice at my own expense for the purpose of determining what...
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How to fill out indiana workers compensation board

01
Obtain the necessary forms from the Indiana Workers Compensation Board (IWCB) website or request them by mail.
02
Fill out the Employer's First Report of Injury or Illness form, providing all required information about the injured worker, the incident, and the nature of the injury or illness.
03
Complete the Employee's Claim Application form, including personal information, details about the injury or illness, and any medical treatment received.
04
Attach any supporting documents, such as medical reports or witness statements, to substantiate the claim.
05
Submit the completed forms and any supporting documentation to the IWCB by mail or online through their electronic filing system.
06
Keep copies of all submitted documents for your records.
07
Await confirmation and further communication from the IWCB regarding the status of the claim.
08
Provide any additional information or documentation requested by the IWCB to process the claim efficiently.
09
Cooperate with the IWCB throughout the claim process, including attending any required hearings or providing updates on the injured worker's condition.
10
Review the decision made by the IWCB regarding the claim and take appropriate actions based on the outcome.

Who needs indiana workers compensation board?

01
Employers in Indiana are required by law to have workers' compensation coverage if they have at least one employee. Therefore, any employer, regardless of their size or industry, needs to have Indiana workers compensation board.
02
Additionally, employees who sustain work-related injuries or illnesses in Indiana may need to file a claim with the Indiana Workers Compensation Board to seek compensation for medical expenses, lost wages, and other benefits provided under the workers' compensation system.
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The Indiana Workers Compensation Board is a state agency responsible for overseeing and regulating workers' compensation claims in the state of Indiana.
Employers in Indiana are required to file with the Indiana Workers Compensation Board.
Employers can fill out the Indiana Workers Compensation Board forms online or by mail.
The purpose of the Indiana Workers Compensation Board is to ensure that injured workers receive the benefits they are entitled to under the law.
Employers must report information about the injury, medical treatment, and any lost wages related to the workers' compensation claim.
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