WCB Mission Statement

To provide efficient dispute resolution for injured workers and employers by administering both formal adjudication and informal dispute resolution services; to serve the public by answering inquiries regarding the Indiana Worker's Compensation system; and to collect statistical information regarding workplace injuries in Indiana.

News and Notices

Website Notices 2/19/2021

 

As of 2/19/2021, SF 36097 can be submitted to the Board electronically here.

 

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.

 

 

Website Notices 12/23/2020

The Second Injury Fund Annual Report and 2021 Assessment has been issued here.

 

Website Notices 12/4/2020

The Second Injury Fund status report is now available. Please click here for more information.

 

Website Notices 7/15/2020

Beginning on Monday, July 20th, Applications for Adjustment of Claim, SF 29109 that do not specify the nature of the accidental injury will be considered “Incomplete."  Forms submitted with language such as “Plaintiff sustained a work-related injury in the course and scope of employment with the Employer” will have to be amended by sending in a new, complete Application. The file date will be the date the original documentation was received. 

Until further notice, the Dispute Termination of Benefits tool will be unavailable as we upgrade our online offerings. We apologize for the inconvenience.

 

Website Notices 7/7/2020

Public Law 139-2020, previously SEA269, went into effect on 7/1/2020. This bill fixes the subrogation statute, changes the method of calculating visual impairments and implements a number of procedural changes.

 

Website Notices 6/26/20

State Mileage rate changed on March 1, 2020 from $0.38 to $0.39 per mile. You can view historic rates here. 

 

Website Notices 6/12/20

Effective Monday, June 15th, 2020, the Worker’s Compensation Board’s offices will be open to the public by appointment only.  Walk-ins will be unable to get into the building and should call (317-233-3009) or email instead at www.in.gov/wcb for an appointment. Those with appointments will be met at the public entrance on the east side of the building.

 In person hearings are being scheduled according to the availability of usual locations while others will continue to be handled telephonically or through written submissions until further notice.  Please refer to the notice from March 20th for further details.  Do not fax filings to the office.  Mail remains the only way to file most pleadings and forms. Thank you.  No file marked copies will be returned without a second copy and a self-addressed, stamped envelope.

Notice of Penalties will be issued soon for untimely filing of FROIs after May 1, 2020, as per website notices dated 2/21/2020 and 3/20/20.  Thereafter, notices will be sent out approximately monthly for untimely FROIs.  No other filing penalties are set to go into effect at this time.

 

Website Notices 6/1/20 

The 2020 Self-Insurance application/renewal is due to the Board by July 31st. Forms and guidelines are now available. Please click HERE for more information and to download the forms.

Please pay via the State’s electronic payment system, which can be accessed at https://www.in.gov/wcb/2516.htm. If you do not already have one, you may obtain a “unique identifier” to pay electronically by contacting the Board. This identifier will insure that your payment is secure and will allow a debit transaction directly from your company’s bank account for a $1.00 State user fee. The fee for using the credit card option will be higher; it is a percentage of your payment. Please always submit your application/renewal form with a your payment.

 

Website Notices 4/2/20

The agency has received numerous questions regarding worker’s compensation coverage for employees who contract Covid-19, particularly those on the front lines.  In Indiana, workers’ compensation benefits are paid by employers, not the State.  Under our laws, the State cannot tell employers they must automatically cover employees who contract Covid-19.  Whether an individual contracts the virus in the course and scope of their employment is a determination that must initially be made by the employer. This decision is routinely made at the time the employee notifies the employer of the injury, or in this case, contraction of the virus. 

It is well accepted that first responders, as defined in P.L.113-2020, and health care providers, as defined at IC 16-18-2-163, as well as others directly involved in the provision of services to those exhibiting symptoms of Covid-19 are more susceptible to contraction of the disease as a direct result of their work duties.   Others whose jobs necessarily entail close interaction with many people in a public setting are also more vulnerable to exposure and possible infection than those working remotely or in a limited office setting. 

Employers are urged to consider making a prospective decision as to whether any vulnerable segment of their workforce will be presumptively covered under the provisions of the Indiana Worker’s Compensation Act should they:
a.)    Be quarantined at the direction of the employer due to a confirmed or suspected Covid-19 exposure,
b.)    Receive a Covid-19 diagnosis from a physician without a test,
c.)    Receive a presumptive positive Covid-19 test, or
d.)    Receive a laboratory-confirmed Covid-19 diagnosis.

Employers are encouraged to relay such decisions to their workforce and workers’ compensation insurance carrier/third party administrator as soon as possible in order to allay fears and expedite the claims process.  Plans of action upon any occurrence listed above should also be communicated.

Questions may be directed to lhamilton@wcb.in.gov

 

 

Website Notices 3/23/20

Effective Tuesday, March 24th through Monday, April 6th, 2020, the Worker’s Compensation Board’s offices will be closed to the public.  Walk-ins will be unable to get into the building and should call (317-232-3808) or email instead at www.in.gov/wcb.  All in person hearings are suspended and will be handled telephonically or through written submissions during this time.  Because the Board cannot conduct live hearings, the previous limitation to one continuance becomes irrelevant.  Please refer to the notice from March 20th for further details.  Do not fax filings to the office.  Mail remains the only way to file most pleadings and forms. Thank you. 

 

Website Notices 3/20/20

The Worker’s Compensation Board is carefully following the direction of Governor Holcomb as details of the outbreak of Covid-19 in Indiana unfold.  If the practices set out herein must be changed, a similar notice will be issued.

Continuity of business is a goal, while also taking steps to keep everyone safe.  While the Board will honor law firm, employer and insurance carrier directives to their staff to not attend live hearings, only one such continuance will be granted per case at this time.  We will expect all professionals to continue to work their cases and make themselves available for telephonic hearings unless a personal condition requires separate consideration. 

If hearings in a particular venue cannot be conducted because of a facility closing, the entire docket will be moved to another date with telephonic hearings available for most cases set for final hearing.   You should check the website of the location for details, but the Board will send out a notice if the docket is set over.  Please do not contact the Board to ask. 

If a hearing location is closed and the parties agree a live hearing is necessary, arrangements may be made to conduct the hearing at our office. 

Individual hearing districts may have specific directives regarding submission of cases for decision.  These will be dispersed to parties in a timely manner.  In all districts, if a telephonic hearing is scheduled, the parties must mail or drop off evidentiary documents and the parties’ stipulations to the Board’s office at least one week before hearing.  

At this time, we will accept electronic signatures on settlement agreements.  Remember that only settlements are to be sent to the district email boxes.   Please read the Notice from March 13th regarding electronic filings.  All other pleadings, agreements and forms must still be mailed to the Board.

As stated in our notice of February 21, 2020, the Board will begin monitoring FROI filings beginning in April.  However, no determination of a start date for issuing penalties has been made at this time.  Please trust we will not do so during this time of flux and without providing advance notice.  However, getting payments out to injured workers and insuring they receive necessary medical care must be paramount for all working within the Indiana workers’ compensation community.

Thank you for working with the Board.  I am convinced you are the best group in the country.  Our offices are open and will remain so, with limited staff, unless we are otherwise instructed by the Governor’s office.

 

Website Notices 3/13/20

 

NEW ELECTRONIC FILINGS- On April 1^st, 2020, the Board will begin accepting Third Party Settlements and Partial Settlement Agreements electronically through the district emails currently used for full and final settlements.  While Third Party Settlements do not require approval from the Board, many do submit them and we will continue to accept them.  This limited set of filings will be processed similarly to full and final settlements.

 

Later this year, the Board will switch to an upload system, at which time other agreed submissions, oaths, appearances and change of venue requests will be accepted digitally.

 

 

Website Notices 2/21/20

 

FROI PENALTIES- On March 20, 2020, the Board will celebrate its first anniversary of using EDI 3.1.  We have seen errors go down steadily. Beginning on April 1, 2020, the Board will begin evaluating the filing of FROIs under 3.1 for timeliness.  FROIs have been filed electronically in Indiana for 20 years.  Penalties for untimely FROI filings after April 1, 2020 will be issued.  The Board will continue to monitor SROI filings, but no penalties are anticipated for untimely SROIs until a later date and will be announced in advance.

 

PPI CALCULATOR- A PPI calculator has been added to the Board website and is available here for all.  Please note the Multi-digit calculation has been removed from the website and is no longer in use.

 

Website Notices 12/23/2019

The Second Injury Fund Annual Report and 2020 Assessment has been issued here.

 

Website Notices 11/7/2019

EDI 3.1 Demystified for Attorneys Webinar/Seminar will be held on Thursday, November 21st from 1pm - 3pm EST. This will be an overview of FROI/SROI reporting as well as a review of common Indiana EDI filing issues and changes.

Update : Access the archived and recorded version of this webinar here https://inwcbedi.info/training

 

Website Notices 10/31/2019

The Second Injury Fund status report is now available. Please click here for more information.

 

Website Notices 6/17/2019

Lump sum payment information must be memorialized through EDI within 30 days of Board approval of a settlement.  This will be done via "PY" followed by an "FN" filing. Please see the updated Settlement Procedures for more information.

 

No compliance measures regarding EDI 3.1 are being taken at this time.  We anticipate beginning to track performance for transactions that were filed on or after October 1, 2019 and no penalties will be issued before December 1, 2019 for EDI 3.1 monitored violations.

 

The Board will be reviewing claims that were filed between September 1, 2018 and March 20, 2019 for compliance matters as previously announced in July 2017.

 

 

Website Notices 5/31/2019

The 2019 Self-Insurance application and guidelines are now available.  Please click here for more information and to download these forms.

 

Website Notices 5/14/2019

An EDI 3.1 Information Webinar with Live Q & A will be held on Tuesday, June 4th from 11:00am - 1:00pm EST. 

Update : Access the archived and recorded version of this webinar here https://inwcbedi.info/training

 

Website Notices 5/3/2019

EDI 3.1 changes and clarifications can be viewed here.

 

Website Notices 4/5/2019

The ODG Drug Formulary training webinar is now available to download. The recorded webinar can be found here. This link will also be available on the Formulary's webpage found under Insurance Carriers.

 

Website Notices 3/21/2019

On March 20, 2019, Indiana transitioned to EDI 3.1 reporting. This necessitated a change in many form processes. SROI reporting has shifted from the Forms Portal to EDI. Errors and bugs are expected but will be corrected as quickly as possible. Please address concerns regarding forms by email to IT@wcb.IN.gov. Thank you for your understanding.

 

Website Notices 12/27/2018

The Second Injury Fund Annual Report and 2019 Assessment has been issued here

 

Website Notices 12/5/2018

Guidance for implementation of Indiana Worker’s compensation formulary is now available here. Please note that the formulary goes into effect January 1st 2019. The guidance provided is not final so please continue to check the WCB website periodically for updates.

 

Website Notices 11/1/2018

The Second Injury Fund status report is now available. Please click here for more information.

 

Website Notices 9/6/2018

Paper settlements documents will no longer be accepted by the Board.  Those sent in or dropped off will be destroyed and the parties informed by phone or e-mail to submit the Agreement and Order as a PDF according to the Checklist and Procedure documents found here . Documents will not be marked Received until processed through the electronic system.  Please know the Board will continue to improve this process as comments are received and notice will always be given through this format and notices on the website. 

 

Website Notices 8/9/2018

On Tuesday, August 21, 2018 at 2:30 Eastern, we will offer a Claims Release 3.1 EDI for First Report of Injury (FROI) and Subsequent Report of Injury (SROI) Webinar Information Session. We strongly encourage all stakeholders to take advantage of this opportunity. The webinar will assist Trading Partners to understand and interpret the technical requirements for Claims Release 3.1 EDI for the State of Indiana. Register here today , for full details click here.

 

Website Notices 6/29/2018

The Board has posted the EDI Claims Release 3.1 Requirement Tables, Version 1.0. The Requirement Tables are immediately available for download on the EDI Requirements Page of INWCB EDI Claims Website: https://INWCBEDI.info/requirements . The Event Table, Element Requirement Table and Edit Matrix each contain a change log worksheet that will identify any changes made to that specific table after these initial requirements are published.

Website Notices 6/12/2018

A new protocol for submitting settlement agreements to the Board will go into effect within the next 30-45 days.  A similar notice will be issued at that time. The Board is working with the Indiana Office of Technology to perfect the procedure and anticipates there may be slight changes; however, the Checklist should be followed whenever possible as of the date of this notice.  Please take a minute to familiarize yourself with, and prepare to meet the requirements which can be found below. Thank you in advance for your assistance as we move to a more efficient means of addressing settlement agreements. 

Settlement Checklist

Settlement Procedure

 

 

Website Notices 5/31/2018

The 2018 Self-Insurance application and guidelines are now available.  Please click here for more information and to download these forms.

Website Notices 5/2/2018

Public Law 204, previously SB290, will go into effect on July 1^st, 2018.  This bill imposes new time frames for completing certain tasks and changes the way penalties are assessed for failing to maintain worker’s compensation insurance coverage on an employer’s workers.  It also extends the renewal period for Second Injury Fund wage replacement benefits from 150 weeks to three years.

Public Law 206, previously SB369, adopts a formulary for certain drugs often prescribed for injured workers. FAQs and guidance will be forthcoming before Appendix A to the Official Disability Guidelines; informally referred to as the “ODG,” will go into effect on January 1, 2019.

 

Website Notices 4/17/2018

The Board will be implementing a new protocol for submitting “C” claim settlement documents in the near future.  The legal environment surrounding Indiana worker’s compensation cases is changing.  We are seeing many more settlements.  Fewer cases are resolved through hearings.  Therefore, once we have the internal processes in place, documents submitted for approval in “C” claims will go to the respective Single Hearing Members. Please disregard any documentation you may have seen, as the Board has not finalized anything in this regard. Thank you.

New Nurse Case Manager Guidelines can be found here.  These replace those previously posted on this website.

 

Website Notices 1/2018

Denial of a Provider Fee Application or refusal to pay a bill from a medical provider for authorized care provided to an injured worker based solely on 631 IAC 1-1-32 (2)(A)(i) is improper.  Provisions in the Indiana Administrative Code are rules authorized by IC 22-3-1-3 to assist the Board in carrying out the Worker’s Compensation Act, not laws themselves.

Medical providers may use the following link available through the Board’s online services to ascertain the name of an injured worker’s employer, worker’s compensation insurance carrier and that carrier’s claim identification number, when available.

No audio or visual recording may be made of any worker’s compensation hearing, conference or proceeding.

Social security numbers (SSN) of injured workers must be redacted from all documentation prior to submission to the Board. The Application for Adjustment of Claim is the only exception to this requirement.

 

 

• Notice: The Second Injury Fund Annual Report and 2018 Assessment has been issued here
• Notice: 

  Indiana is set to formally begin its enforcement protocol concerning the untimely filing of statutorily required forms and payment of benefits.

  There will be a grace period on penalties through September 30, 2017.  During this period, carriers and third party administrators will receive letters and notice of actions found to be in violation of IC 22-3-3-7, 22-3-7-16, 22-3-4-13(a) and 22-3-7-37 so that appropriate remedies can be put in place. We also encourage your comments and concerns with this process so they may be addressed by the Board prior to October 1st, 2017.

  For all injury dates on or after October 1, 2017, penalties will be assessed. Pursuant to IC 22-3-4-15 escalation of penalties will apply where more than one violation occurs in a single cause concerning the same injured worker and the same injury date.

  In the future, violations of 631 IAC 1-1-26 shall also become the subject of notice by the Board. I ask that you look at your practices to make sure they comply with the 15 day time frame.

  Thank you for all you do to get injured workers treated and back to work,

  Linda Hamilton, Chairman

• Notice: This year our two dollar policy assessments will be issued August 1, 2017 with a due date of October 31, 2017. If you have any questions please contact Mary Taivalkoski or David Babcock.
• Notice: No version of a Worker's Compensation Handbook put out by the Worker's Compensation Board of Indiana that can be found online should be relied on as accurate. This website contains updated information and all changes to the law or procedures of the Board will be set out here. Handbooks or Guidelines put out by other organizations are neither reviewed nor approved by the Board for accuracy.
• Notice: Failure to timely submit State Form 48557 as set out at IC 22-3-3-7(b) may result in the rejection of the request for additional time and the imposition of a fine. IC 22-3-4-15.
• Notice: In cases where there is an accident number, filing of an Application for Adjustment of Claim with a stipulated settlement agreement is unnecessary and the Application will no longer be filed or processed.
• Notice: Please note that the carriers direct written premiums should be 889,525,000. Unfortunately, the zeros were initially omitted. Please see the updated Certificate for Worker's Compensation Carriers here.
• Notice: The 2017 Second Injury Fund recommendation report and certificates are now available. Please click here to review.
• Notice: The Second Injury Fund status report is now available. Please click here for more information.
• Notice: Effective Monday, August 1, 2016, the mileage reimbursement rate is increasing from $0.36 per mile to $0.38 per mile.
• Notice: $2 per policy assessment emails were sent out on May 11, 2016 and payments are due on October 31, 2016. This fee is to be paid only by insurance carriers who wrote worker's compensation policies in the 2015 calendar year. If this applies to your company and you did not receive an assessment email, please contact Mary Taivalkoski at mtaivalkoski@wcb.IN.gov for assistance.
• Notice:  Effective Monday, February 22, 2016 the mileage reimbursement rate is decreasing from $0.40 per mile to $0.36 per mile.
• Notice: The 2016 Second Injury Fund recommendation report and certificates are now available. Please click here to review.
• Notice: The Second Injury Fund status report is now available. Please click here for more information.
• Notice: The WCB now offers online payment options which allow you to make payments by eCheck or Credit Card. The online payment tool can be found under Online Services or by clicking here. For a list of payment reasons, please visit the Online Payment Options page.
• Notice: The Indiana Worker’s Compensation Board has issued the following guidelines for the use of Nurse Case Managers (“NCM”) in the administration of compensation claims:
• A NCM may be involved in a claim to schedule appointments, help facilitate care suggested by the medical provider, and to report back to the employer and/or carrier.  However, a NCM should not express opinions, to either the injured worker or the medical provider, regarding an injured worker’s course of medical care or otherwise attempt to influence the process.  Additionally, a claims adjuster should not attempt to direct the care provided to an injured worker by the authorized treating doctor.
• Notice: $2 per policy assessment emails were sent out on June 30, 2015 and payments are due on October 31, 2015. If you did not receive the assessment email, please contact Rob Howell at mailto:rhowell@wcb.IN.gov?subject=%242%20Per%20Policy%20Assessment for assistance.
• Notice: Effective July 1, 2015, the Mileage Reimbursement Rate has been lowered to $.40/Mile. For historical mileage rates, click here.
• Notice: Effective July 1, 2015, TTD/TPD and PPI benefits are increasing. This increase only applies to injuries occurring after 7/1/2015. The revised rates can be found here.
• Notice: The 2015 Self-Insurance application and guidelines are now available.  Please click here for more information and to download these forms.
• Notice: The 2015 Second Injury Fund recommendation report and certification forms are now available.  Please click here to view.
• Notice: The 2015 Second Injury Fund status report is now available.  Please click here to view.
• Notice: As of July 1, 2014, hospitals and hospital facilities are to be reimbursed at 200% of Medicare.  See IC 22-3-3-5.2 (b) and IC 22-3-6-1 (j).
• Notice: As of July 1, 2014, Reimbursement for Repackaged Drugs has been limited.  See IC 22-3-3-4.5.
• Notice: The Agreement to Compensation - SF 1043 form is now available via the Board's Forms Portal system. Currently, it is only to be used to file compliance copies of TTD or TPD agreements. PPI and PTD agreements must still be filed in hardcopy.
• Notice: Effective July 1, 2014, TTD/TPD and PPI benefits are increasing. This increase only applies to injuries occurring after 7/1/2014. The revised rates can be found here.
• Notice: The Board has made available the guidelines for determining the pecuniary liability of an employer to a medical service facility. This document can be found here.
• Notice: The 2014 Second Injury Fund recommendation report and certificates are now available. Please click here to review.
• Notice: Please note that the Notice of Suspension of Compensation and/or Benefits - SF 54217 form has been revised to allow for the suspension of compensation as well as benefits.  As a result, please refrain from utilizing the Report Of Temporary Total Disability (TTD)/Temporary Partial Disability (TPD) Termination/Reduction - SF 38911 to suspend a TTD/TPD agreement.  The purpose of the 38911 is to terminate a TTD/TPD agreement whereas the 54217 should be used to suspend.
• Notice: Effective Monday, February 25, 2013, the Worker's Compensation Board of Indiana will no longer process 1043 agreements or waivers for 0% PPI ratings UNLESS filed as part of an agreed to stipulation, as required by 631 IAC 1-1-11.
• Notice: The 2013 Second Injury Fund Report and Assessment, along with relevant certificates, are now ready and have been uploaded to our website.  Please click here to review and complete.
• Notice: The pilot program which was launched to test a new, online method of forms submission has concluded and the results have been extremely favorable.  This tool is now available to the general public.  A link to the tool may be found under the "Online Services" portion of this page which is located in the upper, right-hand corner.  Upon accessing the tool, you will be given the option to either register or login.  Registration is fairly simple but please be prepared to provide the FEIN of your company.  The system will automatically assign a username and password and provide that information to the user via e-mail.  The password can be changed but the username cannot.  Once you have received your credentials, you may login immediately.  Upon doing so, you will have the opportunity to edit your account or input forms.  Currently, the available forms are limited to the Notice of Inability to Determine Liability/Request for Additional Time - SF 48557, Notice of Denial of Benefits - SF 53914 and Notice of Suspension of Compensation and/or Benefits - SF 54217.  Regardless of the form chosen, you will be asked to identify your claim by providing the social security number and date of injury.  Upon claim identification, the system will ask a few form-relevant questions.  Once answered and submitted, you will receive immediate feedback via e-mail.  If no first report of injury is on record for a given claim, you will not be able to proceed.
• In response to overwhelming public concern, we have migrated this tool to a secure environment.  As such, we have adjusted the timeframe for adoption.  While we encourage immediate adoption of this system, we will continue to process forms received via postal mail until Monday, January 7, 2013.  If you require additional time to make this change, please petition the Board.  If you encounter any issues with this new system, please contact Rob Howell.
• Notice: On August 1, 2012, the Board released revised versions of both the Notice of Inability to Determine Liability / Request for Additional Time - SF 48557  and the Notice of Denial of Benefits - SF 53914 forms.  The purpose of the revisions is to provide a means for adjustors to communicate the medical-only period of a claim.  Our compliance program has demonstrated that many of the penalties we have issued for lack of timely filing are, ultimately, due to a medical-only period preceding an alleged disability.  As we appeared to be rescinding a great number of penalties due to this situation, the decision was made to alter the most relevant forms to capture the medical-only period thereby avoiding future, inappropriate notices of penalty.  We would ask that all parties begin utilizing these new forms exclusively by no later than September 26, 2012.  In addition, the Board is currently conducting a pilot program of an online data capture system that will, eventually, replace these forms.  The pilot program will run for no fewer than sixty (60) days.  Upon completion, we will post notice and usage instructions on our website along with a timeline for mandatory adoption.
• Thank you for your patience and assistance as we continue to develop both our compliance program and our electronic filing system.
• Notice: The following is a brief clarification regarding permanent partial impairment (PPI) ratings to the shoulder and hip.  Please note that when injuries are specific to either of those body parts, because both are part of the torso, the impairment rating should be made to the body as a whole.  This explanation is intended to provide clarity and direction to all involved parties, particularly physicians, who make the actual assessments on which we all rely.  Please contact Kathy Haynes for assistance with or  questions regarding the calculation of ratings.
• Notice: The 2012 Self-Insurance application and guidelines are now available.  Please click here for more information and to download these forms.
• Notice: Effective May 21, 2012, the Worker's Compensation Board of Indiana will require that all filings be made on the most recent State form.  These forms are available on our website and notice will be given via e-mail to our newsletter subscribers when a form has been amended.  Filings made on outdated forms will be rejected and may subject the filer to penalties related to tardiness.  For questions or assistance with forms, please contact Alan Buckley or Dirinda Asher.
• Clarification Regarding Report of Attending Physician Form: As of this date, usage of the new State Form 2118, Report of Attending Physician, shall not be mandatory. 
  
  The new SF 2118 is clear, concise and, most importantly, relevant to how PPI awards are accurately calculated for approval.  Adjusters will ultimately be required to use it, as well as the electronic versions of SF 1043 and 38911, in the upcoming year.  However, the Board will give advance notice of this requirement. 
  
  Physicians will not be asked to complete this form but should use it as a guideline while dictating their own.  We do encourage all interested parties to begin using this form, to which the physician's dictated report can be attached, as soon as practicable.  Thank you for your consideration and support.
• Notice: The Board is hereby and immediately requesting that all Agreement to Compensation (SF 1043), Notice of Suspension of Medical Benefits (SF 54217), Notice of Denial of Benefits (SF 53914) and Request for Additional Time (SF 48557) forms be proceeded by an electronically filed First Report of Injury (FROI).  Failure to do so will result in the rejection of your form.  This is an administrative ruling.
• Notice: Please note that ALL balanced bill provider fee applications must be accompanied by the $60 filing fee.  The presence of an existing application for adjustment of claim has no bearing on this mandate.  Balanced bill provider fee applications received since 7/1/2011 are subject to this fee and will not be processed unless accompanied by said payment.