Indiana workers’ compensation information and forms
Workers’ compensation insurance employee notification. To get the help you need to ensure employees understand coverage and how to report a work place injury, select the link located below.
- 221-10000 – Claim kit cover letter
Letter from The Hanover welcoming the employer to the insurance plan, includes instructions for claim reporting and creating medical provider panels.
- 221-10001 – Take control of workers' compensation costs
This guidance will help ensure the best outcome for you and your employees following a work related injury.
- WC7630a – Workers' compensation notice
Required to be conspicuously posted at the employer's place of business so all employees have access to it.
- WC8804a – Workers' compensation notice (Spanish)
Spanish version-Required to be conspicuously posted at the employer's place of business so all employees have access to it.
- WC7703f – First report of employee injury, illness
This form is completed by the employer to report an on the job injury or accident involving an employee.