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TERMINATION OF BENEFITS/REQUEST FOR INDIANA WORKER\'S COMPENSATION BOARD 402 West Washington Street, Room W196 Indianapolis, IN 46204 Telephone: (317) 2323808 www.in.gov/wcbState Form 38911 (R9 /

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How to fill out indiana workers compensation board

01

Obtain the necessary forms from the Indiana Workers Compensation Board website or office.

02

Fill out the employee section of the form with your personal information, including name, contact information, and social security number.

03

Provide details about the injury or illness that occurred at work, including the date, time, and location.

04

Include information about your employer, such as their name, address, and contact information.

05

Sign and date the form before submitting it to the Workers Compensation Board.

Who needs indiana workers compensation board?

01

Employees who have suffered a work-related injury or illness in the state of Indiana.

02

Employers who need to report a work-related injury or illness involving one of their employees.

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What is indiana workers compensation board?

The Indiana Workers Compensation Board is a state agency responsible for handling disputes related to workers' compensation claims in Indiana.

Who is required to file indiana workers compensation board?

Employers in Indiana are required to file with the Workers Compensation Board.

How to fill out indiana workers compensation board?

Employers can fill out the Indiana Workers Compensation Board forms online or submit them by mail.

What is the purpose of indiana workers compensation board?

The purpose of the Indiana Workers Compensation Board is to ensure that employees who are injured on the job receive the benefits they are entitled to.

What information must be reported on indiana workers compensation board?

Employers must report information such as the employee's name, date of injury, and details of the accident.

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