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Reporting Procedures
EMPLOYEE IS INJURED
If Injury results in death or overnight hospital stay call IPEP immediately at 800-382-8837.
COMPLETE FORMS AND SUBMIT TO IPEP
1. FIRST REPORT OF INJURY (Completed by Employer)
2. SUPERVISOR'S INCIDENT REPORT (Completed by Employer)
3. MEDICAL AUTHORIZATION FORM (Completed by Employee)
fax 765-868-3310
IS TREATMENT REQUIRED?
YES
DIRECT EMPLOYEE TO DESIGNATED OCC HEALTH CLINIC OR ER
CONTACT IPEP FOR ANY REFERRALS
NO
CLAIM IS SET UP AS A RECORD ONLY WITH IPEP
CONTACT IPEP ASAP IF TREATMENT BECOMES NECESSARY
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