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  • Indiana Workers Compensation First Report Form

Get Indiana Workers Compensation First Report Form

FOR WORKER S COMPENSATION BOARD USE ONLY INDIANA WORKER S COMPENSATION FIRST REPORT OF EMPLOYEE INJURY ILLNESS Jurisdiction claim number Process date State Form 34401 R9 / 3-01 PLEASE TYPE or PRINT IN INK Please return completed form electronically by an approved EDI process.

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If you are injured while working at your job, you may be entitled to workers' compensation benefits. Q: When should I report an accident that happened on the job? A: You should report any accident to your employer (boss, foreman, or supervisor) immediately. If you wait more then 30 days your claim may be denied.

DWC-1 Workers Compensation Claim Form. This is the form you will complete and send to EMPLOYERS to initiate the claim process for your employee. This form must be completed and provided to EMPLOYERS within one working day from you becoming aware of a work-related injury or occupational disease.

In Indiana employers are required to purchase workers' compensation coverage if they employ one or more workers. Sole Proprietors, Partners and LLC Members are all excluded from coverage, but have the option to be included. Corporate Officers are included in coverage, but may elect to included.

The failure to report an injury could result in fines or even jail time. Once you submit the form, the insurer must submit a copy to the Workers' Compensation Board and accept or deny the claim within 29 days.

An employer who fails to carry insurance or self-insure its workers compensation liability commits a Class A infraction (IC 22-3-4-13 and IC 22-3-5-1). The WC Board could order: Fine up to $10,000.

If you are injured while working at your job, you may be entitled to workers' compensation benefits. Q: When should I report an accident that happened on the job? A: You should report any accident to your employer (boss, foreman, or supervisor) immediately. If you wait more then 30 days your claim may be denied.

Employees must report injuries or illnesses within 30 days if they are in an accident while on the job. Waiting more than 30 days could mean an employee's claim is denied. After hearing about an employee's injury, you have seven days to report it to your insurance carrier.

How much does workers' compensation insurance cost in Indiana? Estimated employer rates for workers' compensation in Indiana are $0.68 per $100 in covered payroll. Your cost is based on a number of factors, including: Payroll.

How to File a Workers' Compensation Claim in Indiana Step-by-step process for filing a workers' comp claim. ... Step #1: Seek medical attention. ... Step #2: Notify your employer. ... Step #3: Make certain your employer files the necessary form. ... Step #4: Wait to receive a decision from the insurance company.

Waiting more than 30 days could mean an employee's claim is denied. After hearing about an employee's injury, you have seven days to report it to your insurance carrier.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232